局部浸润麻醉在超普疝装置修补腹股沟疝的应用

摘要] 目的 探讨局部浸润麻醉下应用超普疝装置（UHS）修补腹股沟疝的手术过程中如何减轻患者的痛苦不适感及预防术后腹股沟区慢性疼痛发生的方法。方法 采用2%利多卡因15ml与0.75%布比卡因5ml或1%罗派卡因10ml用生理盐水稀释至60-65ml的混合液为浸润麻醉药。分离腹膜前间隙之前向间隙内注射以上配制的局麻药10-15ml进行浸润麻醉；在手术过程中缝合固定补片结扎缝线时询问患者是否有疼痛感。结果 分离腹膜前间隙时感觉有明显疼痛的患者（NRS评分≥4）：A组（未向腹膜前间隙注射局麻药）为100%(20/20), B组（向腹膜前间隙注射局麻药）为7.79%(6/77),两组差异非常显著(P﹤0.01)；手术过程中缝合固定补片结扎缝线时有18.56%(18/97)的患者出现明显的疼痛感，当拆除结扎有疼痛感的缝线后，该处的疼痛感立即消失。但手术操作时间、住院时间、术中出血量、术后疼痛强度、术后疼痛持续时间、术后并发症发生比例、复发情况比较，两组均无统计学差异（P﹥0.05）。结论 分离腹膜前间隙之前向间隙内注入局麻药进行浸润麻醉的方法，可以明显减轻分离腹膜前间隙时给患者带来的痛苦不适感；采用局部麻醉，术中可与患者交流互动，能有效避免缝扎神经或骨膜所致的术后疼痛。因此，采用恰当的局部麻醉和手术操作方法，可以明显减轻超普疝装置修补腹股沟疝手术术中及术后患者的痛苦不适。

Application of local anaesthesia in ultra-prolene hernia system for repair of inguinal hernia

Abstract] Object To expore how to relieve the sufferings of patients during the operation of inguinal hernia repair using ultra-prolene hernia system under local anaesthesia and prevent postoperative pain in the inguinal region. Methods The mixed solution, consisted of 2% lidocaine (15mL) and 0.75% bupivacaine (5mL) or 1% ropivacaine (10mL), and diluted to 60 to 65 mL with saline, used as a local anaesthetic. Before separating preperitoneal space (Brogros space), 10 to 15 mL of the local anaesthetic was injected into the space for local infiltration (group B, n=77). Assessment of pain extent during suturing and fixing mesh was determined by numerical rating scale (NRS). 20 patients without undergoing injection of local anaesthetic were as controls (group A). Results All of controls (20/20,100%) felt apparent pain（NRS≥4）during separating preperitoneal space in group A, however only 6 cases in group B showed apparent pain (7.79%). The difference was significantbetween two groups (P<0.01). During suturing and fixing mesh, 18.56% patients (18/97) in group B felt pain of ligation, and the pain relieved promptly after removing the stitch causing pain. The operative time, length of hospital stay, blood loss, postoperative pain intensity and duration, complications, and recurrence rate between two groups had no significant differences (P>0.05). Conclusions The method that injecting the local anaesthetic into Brogros space for local infiltration during operation can alleviate the pain caused by performance of separating preperitoneal space. During inguinal hernia repair under local anaesthesia, informed the pain on patients when suturing and fixing mesh is helpful to prevent pain causing by ligation.