超声引导下腹横肌平面阻滞用于≥70岁患者腹股沟疝修补术术后镇痛的临床观察

目的观察超声引导下腹横肌平面（TAP）阻滞对于≥70岁患者开放性腹股沟疝修补术术后镇痛的影响。 方法选择择期行开放性腹股沟疝无张力修补术患者60例，采用蛛网膜下腔阻滞麻醉，均为男性，年龄≥70岁，美国麻醉师协会分级Ⅰ~Ⅱ级，采用随机数字表法将患者分为对照组和试验组，每组30例。试验组于手术结束后于患侧行超声引导下TAP阻滞。观察2组患者术中、术后有无恶心、呕吐、心慌、胸闷、呼吸困难及头晕、嗜睡等不良反应；记录试验组术中、术后有无血管、神经及腹腔脏器损伤，局部麻醉药物中毒、穿刺部位感染等不良事件发生；记录2组患者术后4、6、8、12、24 h时静息状态下和咳嗽时视觉模拟量表（VAS）评分；记录术后下床时间、术后住院天数、总住院天数、麻醉费用以及住院总费用，记录2组术后非甾体类镇痛药的使用例数。 结果2组患者术中、术后均无恶心、呕吐、心慌、胸闷、呼吸困难及头晕、嗜睡等不良反应。试验组患者术中、术后无血管、神经及腹腔脏器损伤，无局部麻醉药物中毒及穿刺部位感染等不良事件。对照组在静息状态下［4 h：（3.8±1.2）分vs （1.6±0.5）分；6 h：（4.2±1.5）分vs （1.8±0.8）分；8 h：（4.8±1.5）分vs （2.0±0.7）分；12 h：（5.2±1.4）分vs （2.2±0.6）分；24 h：（3.2±?.?）分vs （1.6±0.6）分］和咳嗽时［4 h：（3.9±1.3）分vs （1.8±0.8）分；6 h：（4.6±1.5）分vs （2.0±0.8）分；8 h：（5.5±1.6）分vs （2.2±0.9）分；12 h:（5.8±1.8）分vs （2.4±0.8）分；24 h：（4.6±1.4）分vs （1.8±0.7）分］不同时间点的VAS评分均大于试验组（P<0.01）；2组住院总费用差异无统计学意义，试验组麻醉费用高于［（780.06±63.10）元vs （566.69±93.23）元］、下床活动时间早于［（5.26±1.43）天vs （8.62±1.62）天］、非甾体类药物使用例数少于（2 vs 28）对照组（P<0.01）。 结论超声引导下TAP阻滞因其镇痛效果确切，且操作简单，相关并发症少，对于≥70岁患者的开放性腹股沟疝修补术是一种安全有效的术后镇痛方法。

Ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients ≥ 70 years old undergoing inguinal hernia repair

ObjectiveTo observe the efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in elderly patients ≥70 years old undergoing inguinal hernia repair. MethodsSixty American Society of AnesthesiologistsⅠ orⅡ patients, aged ≥70 years old, scheduled for elective unilateral inguinal hernia repair under spinal-epidural anesthesia were randomly divided into two groups (n=30 each) using a random number table: control group and test group. Ultrasound-guided TAP block was performed at the end of surgery in the test group. Adverse reactions such as nausea, vomiting, palpitation, dyspnea, dizziness, and sleepiness in the two groups were observed during and after operation. In the test group, the occurrence of adverse events such as blood vessel, nerve, and abdominal organ injury, local anesthetic toxicity, and puncture site infection related to nerve block during and after operation were recorded. Visual analog scale (VAS) scores at rest and cough were recorded at 4, 6, 8, 12, and 24 hours after operation in both groups. Time to ambulation after operation, days of hospitalization after operation, total days of hospitalization, cost of anesthesia, and total cost of hospitalization were recorded. The use of non-steroidal analgesics in the two groups after operation was also recorded. ResultsThere were no adverse reactions such as nausea, vomiting, palpitation, dyspnea, dizziness, or sleepiness during and after operation in both groups. All patients in the test group had no injuries of blood vessels, nerves, and abdominal organs, local anesthetic toxicity, or puncture site infection during and after operation. VAS scores at resting state 4 h: (3.8±1.2) points vs (1.6±0.5) points; 6 h: (4.2±1.5) points vs (1.8±0.8) points; 8 h: (4.8±1.5) points vs (2.0±0.7) points; 12 h: (5.2±1.4) points vs (2.2±0.6) points; 24 h: (3.2±?.?) points vs (1.6±0.6) points] and cough 4 h: (3.9±1.3) points vs (1.8±0.8) points; 6 h: (4.6±1.5) points vs (2.0±0.8) points; 8 h: (5.5±1.6) points vs (2.2±0.9) points; 12 h: (5.8±1.8) points vs (2.4±0.8) points; 24 h: (4.6±1.4) points vs (1.8±0.7) points] at different time points were significantly higher in the control group than in the test group (P<0.01). The cost of anesthesia in the test group was significantly higher (780.06±63.10) yuan vs (566.69±93.23) yuan] than that in control group (P<0.01). There was no significant difference in the total cost of hospitalization between the two groups. The time to ambulation in the test group was earlier (5.26±1.43) days vs (8.62±1.62) days] than that in the control group (P<0.01), and the number of non-steroidal drugs used in the test group was significantly less (2 vs 28) than that in the control group (P<0.01). ConclusionUltrasound-guided TAP block is a safe and effective method for postoperative analgesia in elderly patients ≥70 years old after open inguinal hernia repair.