肿胀麻醉技术在腹股沟疝腹膜前间隙修补术中应用的回顾性分析

目的 评价肿胀麻醉技术在腹股沟疝腹膜前间隙修补手术的疗效及安全性.方法 回顾性分析本院2012年1月至2016年3月诊断为腹股沟疝患者的临床资料.根据病例资料术中麻醉方法不同分为两组,采用0.5％利多卡因的常规局部麻醉(LA组)和采用肿胀麻醉(TLA组),均使用强生公司疝修补装置(ultrapro hernia system,UHS)补片行腹膜前间隙修补完成手术.以手术时间、术中利多卡因的使用剂量、术后镇痛效果持续时间、术后3d疼痛消失例数、术后1d止痛药使用例数、术后7d疼痛发生例数,以及术后并发症发生率作安全性指标.结果 共筛选出86例术中采用常规局部麻醉的临床资料,98例术中采用肿胀麻醉的临床资料.两组的一般资料比较差异无统计学意义(P＞0.05).两组均顺利完成手术,未出现局麻中毒反应,术中均未更改麻醉方法.TLA组利多卡因使用量和手术时间明显低于LA组(140 ±8)mg vs (278 ±9)mg;(41 ±7)min vs(48 ±7)min,P＜0.01],术后镇痛持续时间长于LA组(4.2±0.8)h vs(1.2±0.3)h,P＜0.01],TLA组术后ld使用镇痛药物的比例低于LA组(P＜0.01),两组术后3d疼痛消失例数、持续性疼痛发生率,术后并发症发生率差异均无统计学意义(P＞0.05).结论 肿胀麻醉在腹股沟疝腹膜前修补术中缩短了手术时间,减少了利多卡因用量,有良好的术中麻醉镇痛效果以及安全性,术后镇痛持续时间优于常规局部麻醉.

Tumescent local anesthetic technique for preperitoneal tension-free hernioplasty: a retrospective study

Objective To evaluate the efficacy and safety of tumescent local anesthetic (TLA) technique for preperitoneal tension-flee hernia repair.Methods The clinical data of 184 patients with inguinal hernia undergoing surgical treatment in our hospital from January 2012 to March 2016 were collected and analyzed retrospectively.According to the different of intraoperative anesthetic methods,these patients were divided into local anesthetic group (normal local anesthesia with 0.5％ lidocaine) and TLA group.Both groups were treated by ultrapro hernia system (UHS).The operative time,analgesia duration,incidence rate of persistent pain,use of medication in the first postoperative day,and the number of the cases with pain disappeared in 3 d after operation were taken as the efficacy variables,and the doses of lidocaine used,and postoperative complication rate were taken as the safety indicators.Results There were 86 patients in the LA group and 98 patients in the TLA group enrolled in our study,and no significant differences were seen in the general data between them (P ＞ 0.05).Successful operation was obtained in both groups,and no side reactions of local anesthetic intoxication were seen in them.The mean doses of lidocaine consumed (140 ± 8 vs 278 ±9 mg,P ＜0.01) were lower,and the mean operation time (41 ± 7 vs 48 ± 7 min,P ＜ 0.01) was shorter in the TLA group than the LA group.The TLA group had longer duration of analgesia (4.2 ± 0.8 vs 1.2 ±0.3 h,P ＜0.01) and less use of analgesics (P ＜0.01) within 1 d postoperatively than the LA group.There were no significant differences in other parameters between the 2 groups.Conclusion TLA in inguinal hernia repair can reduce the operative time and usage of lidocaine,and achieve sound safety and good intraoperative analgesic effect.What's more,it has superior in analgesic duration to conventional anesthesia.