Evaluation of Ultrasound-guided Genitofemoral Nerve Block Combined with Ilioinguinal/iliohypogastric Nerve Block during Inguinal Hernia Repair in the Elderly

To evaluate the anesthetic effect of ultrasound-guided(USG)ilioinguinal/iliohypogastric nerve(Ⅱ/IHN)block combined with genital branch of genitofemoral nerve(GFN)block in the elderly undergoing inguinal hernia repair,54 old patients(aged 60-96years,ASAⅠ-Ⅲ)with indirect hernia were enrolled and scheduled for unilateral tensiofree herniorrhaphy.Patients were grouped randomly to receive either USGⅡ/IHN plus GFN block(Group G)or USGⅡ/IHN block alone(GroupⅠ).The intraoperative visual analogue scale(VAS)scores were recorded at skin incision,at spermatic cord/round ligament traction and at sac ligation.The resting and dynamic VAS scores were recorded postoperatively.The requirements of extra sedatives and analgesics for intra-and postoperative analgesia were assessed.Occurrence of complications of the block,postoperative nausea and vomiting and femoral nerve palsy was also reported.Both groups showed similar sensory block.When stretching spermatic cord/round ligament,the patients in group G had significantly lower VAS scores than in group.And group G used much fewer adjuvant sedatives and analgesics to achieve adequate anaesthesia.In addition,group G was presented with better intraoperative anaesthesia and lower postoperative dynamic VAS scores at all time points tested.No significant difference was found in the postoperative requirement of rescue medication.Both groups showed no complications related to the block and group G reported no femoral nerve palsy.The addition of GFN block toⅡ/IHN block improves the quality of perioperative anesthesia and analgesia in the elderly and reduces the consumption of extra sedatives and analgesics during the surgery.

髂腹下-髂腹股沟-生殖股神经生殖支联合神经阻滞在老年患者无张力疝修补术中的应用

目的评价髂腹下-髂腹股沟-生殖股神经生殖支联合神经阻滞、蛛网膜下腔阻滞和局部麻醉对老年患者无张力疝修补术的麻醉效果、血流动力学影响及术后不良反应。方法选择120例行无张力疝修补术的老年患者,随机分为3组,每组40例,分别实施髂腹下-髂腹股沟-生殖股神经生殖支联合神经阻滞(A组)、蛛网膜下腔阻滞(B组)、局部麻醉(C组)。记录3组麻醉效果及麻醉前和麻醉后15、30、60、90 min的平均动脉压(MAP)和心率(HR),升压药的用量及术后情况。结果B组患者在麻醉后15 min和30 min的MAP明显低于A组、C组(P<0.05),B组尿潴留、头痛、恶心呕吐发生率显著高于A组、C组(P<0.05),患者满意度A组、B组显著高于C组(P<0.05)。结论应用神经刺激器定位技术下行髂腹下-髂腹股沟-生殖股神经生殖支联合神经阻滞的麻醉效果满意,对血流动力学影响小,不良反应少,是老年患者行无张力疝修补术理想的麻醉选择。

超声引导下髂腹股沟/髂腹下神经阻滞联合生殖股神经生殖支阻滞在老年腹股沟疝修补术中的应用效果

目的观察超声引导下髂腹股沟/髂腹下神经(ilioinguinal/iliohypogastric nerve,IIIHN)阻滞联合生殖股神经生殖支阻滞应用于老年腹股沟疝修补术的效果。方法择期行单侧无张力疝修补术的腹股沟斜疝老年患者53例,男52例,女1例,年龄65~96岁,体重55~82 kg,ASAⅠ-Ⅲ级,采用随机数字表法将患者随机分为两组:IIIHN阻滞联合生殖股神经生殖支阻滞组(G组,n=27例)和IIIHN阻滞组(I组,n=26例)。两组均行超声引导下IIIHN阻滞,注入0.5%罗哌卡因0.25 ml/kg。G组联合生殖股神经生殖支阻滞,注入0.5%罗哌卡因10 ml。阻滞完成30 min后测试皮区感觉神经阻滞效果,记录切皮时、牵拉精索/圆韧带时、行疝囊高位结扎时的VAS疼痛评分,记录术中舒芬太尼、布托啡诺使用情况和术后曲马多补救镇痛情况,记录区域阻滞效果评级以及穿刺部位血肿、腹内脏器损伤、股神经被阻滞表现、阻滞后感觉异常、局麻药中毒、术后恶心呕吐、尿潴留等并发症的发生情况。结果两组皮区感觉神经阻滞效果差异无统计学意义。切皮时和行疝囊高位结扎时两组VAS疼痛评分差异无统计学意义。牵拉精索/圆韧带时G组VAS疼痛评分明显低于I组[(2.0±1.0)分vs(4.7±1.4)分,P<0.05]。G组术中舒芬太尼、布托啡诺使用率明显低于I组(P<0.05)。两组术后曲马多补救镇痛率差异无统计学意义。G组区域阻滞效果评优者比例明显高于I组[25例(92%)vs 8例(31%),P<0.05],区域阻滞效果评良者比例明显低于I组[2例(7%)vs 18例(69%),P<0.05]。两组各有1例发生术后尿潴留,两组均无其他并发症发生。结论髂腹股沟/髂腹下神经阻滞联合生殖股神经生殖支阻滞应用于老年腹股沟斜疝修补术,效果优于髂腹股沟/髂腹下神经阻滞。