腰方肌阻滞麻醉和局部浸润麻醉对腹股沟疝修补术患者术中及术后的镇痛效果

Comparison of analgesic effect between lumbar quadratus block anesthesia and local infiltration anesthesia in patients undergoing inguinal hernia repair surgery during and after anesthesia

目的比较腰方肌阻滞麻醉和局部浸润麻醉两种不同麻醉方式对腹股沟疝手术患者麻醉术中及术后镇痛效果的差异性。方法收集2017年10月至2018年2月,四川大学华西医院接受腹股沟疝修补术的男性患者40例,随机分为A组腰方肌阻滞组20例和B组传统局部浸润麻醉组20例,分别进行相应方式麻醉,A组麻醉由麻醉师在超声引导下完成,B组麻醉由手术医师完成,待麻醉发挥效应后开始进行手术,术中记录麻醉操作所用时间,麻醉完成至手术开始平均等待时间,单纯手术时间,总手术时间(包括入麻醉操作时间、麻醉后等待时间以及单纯手术操作时间);手术开始作切口时对患者进行疼痛视觉模拟评分法(VAS)评分,结束时VAS评分,术中最大疼痛评分,术后6 h疼痛评分。结果A组患者麻醉操作平均时间为7.1 min,麻醉完成至手术开始平均等待时间23.8 min;总手术时间平均为62.8 min。手术开始作切口时VAS评分平均为2.3分,结束时VAS评分平均为0.8分;术中最大疼痛值平均为2.8分,术后6 h疼痛评分平均为1.5分。B组患者麻醉操作平均时间1.8 min,麻醉完成后至开始手术等待时间平均0.4 min;总手术时间平均为37.9 min;手术开始作切口时VAS评分平均约0.2分,结束时VAS评分平均约0.1分。术中最大疼痛评分平均约1.3分,术后6 h疼痛评分平均为4.1分,2组比较差异有统计学意义(P<0.05)。A组患者单纯手术时间平均为32.8 min,B组患者单纯手术时间平均为35.8 min,2组比较差异无统计学意义(P>0.05)。结论传统局部浸润麻醉等待时间短,术后并发症少,术中需要随时追加麻醉药物,且与手术医师的麻醉技巧和手术操作熟练程度有关。腰方肌阻滞麻醉的术后镇痛效果明显优于局部浸润麻醉,但术中镇痛效果稍差于局部浸润麻醉,且麻醉医师需要一定学习曲线,所以具体选择何种麻醉方式应根据各自所在医疗单位的技术水平和手术医师的熟练程度来决定。

Objective To compare the analgesic effects of lumbar quadratus block anesthesia and local infiltration anesthesia on patients undergoing inguinal hernia surgery during and after anesthesia.Methods Forty male patients undergoing inguinal hernia repair in West China Hospital from October 2017 to February 2018 were randomly divided into two groups.20 patients in group A with lumbar quadratus block who were anesthetized by anesthesiologist under the guidance of ultrasonic and 20 patients in group B with traditional local infiltration anesthesia by the surgeon.We recorded the average waiting time from the completion of anesthesia to the beginning of the operation,the operation time,the total operation time(including the operation time into anesthesia,the waiting time after anesthesia and the operation time alone);the patients were scored by visual analogue score(VAS)at the beginning of the operation,the VAS score at the end of the operation,the maximum pain score during the operation,and the pain score 6 hours after the operation.Results In group A,the average anesthesia operation time was 7.1 minutes,and the average waiting time from the completion of anesthesia to the beginning of operation was 23.8 minutes.The average total operation time for group A was 62.8 minutes.The average VAS score was 2.3 at the beginning of the operation and 0.8 at the end of the operation.The average maximum intraoperative pain score was 2.8,and the average 6-hour post-operation pain score was 1.5.In group B,the average time of anesthesia operation was 1.8 minutes,the average waiting time from the completion of anesthesia to the beginning of operation was 0.4 minutes,the average total operation time was 37.9 minutes,the average VAS score at the beginning of operation was about 0.2 points,and the average VAS score at the end was about 0.1 points.The maximum intraoperative pain score averaged about 1.3 points,and the pain score averaged 4.1 points at 6 hours after operation,there was a significant difference between the two groups(P<0.05).The average operation time of group A was 32.8 minutes,while that of group B was 35.8 minutes,there was no significant difference between the two groups(P>0.05).Conclusion Traditional local infiltration anesthesia has a short waiting time and fewer complications.Additional anesthetics are needed at any time during the operation,which is related to the anesthesia skills of the surgeon and the proficiency of the operation.Postoperative analgesic effect of lumbar quadratus block anesthesia is obviously better than that of local infiltration anesthesia,but intraoperative analgesic effect is slightly worse than that of local infiltration anesthesia,and anesthesiologists need a certain learning curve,so the specific choice of anesthesia methods should be based on the technical level of their respective medical units and the proficiency of the surgeon.