Comparison of the anesthetic effects of two anesthesia methods for inguinal hernia repair in elderly patients / 中国医师进修杂志

ABSTRACT

Objective:To compare the effects of ultrasound-guided double transverse abdominis plane block (TAPB) under regional anesthesia sedation and local infiltration anesthesia in inguinal hernia repair in elderly patients.Methods:A total of 60 elderly patients who underwent unilateral inguinal hernia repair in Shengjing Hospital of China Medical University from March to September 2019 were selected. The patients were divided into 2 groups by random digits table method. Thirty cases were treated with ultrasound-guided double TAPB (lateral TAPB combined with iliohypogastric/ilioinguinal TAPB) under regional anesthesia sedation (observation group) and 30 cases with local infiltration anesthesia (control group). The local anesthetic was 0.375% ropivacaine in observation group and 0.5% lidocaine in control group. The mean arterial pressure (MAP) and heart rate were recorded at these time points: preanesthesia (T 1), beginning of skin incision (T 2), operation of external oblique aponeurosis (T 3), anatomy of hernial sac (T 4), operation of placing patch (T 5), suturing of external oblique aponeurosis (T 6) and closing skin incision (T 7). The visual analogue scale (VAS) at T 2 to T 5 and 2, 4, 6, 12 and 24 h after surgery were recorded. The occurrence of general anesthesia, postoperative remedial analgesia, nausea and vomiting, local anesthetic intoxication, accidental intraperitoneal injection and cardiovascular and cerebrovascular accident were recorded. Results:Both groups of patients were successfully anesthetized and completed the operation. There was no statistically significant difference in operation time between observation group and control group: (37.20 ± 6.46) min vs. (38.03 ± 4.87) min, P>0.05. There were no statistical difference in MAP and heart rate at T 1 between 2 groups ( P>0.05). The MAP and heart rate at T 2 to T 7 in observation group were significantly lower than those in control group, and there were statistical differences ( P<0.05). The VAS at T 2 to T 5 and 4 to 12 h after operation in observation group was significantly lower than that in control group: (1.87 ± 0.94) scores vs. (4.73 ± 1.11) scores, (1.33 ± 0.24) scores vs. (6.77 ± 1.04) scores, (2.10 ± 0.99) scores vs. (7.30 ± 0.65) scores, (2.39 ± 0.63) scores vs. (5.07 ± 0.87) scores, (2.60 ± 0.17) scores vs. (4.47 ± 0.65) scores, (3.13 ± 0.51) scores vs. (6.32 ± 0.44) scores and (4.28 ± 0.76) scores vs. (6.60 ± 0.57) scores, and there was statistical difference ( P<0.05). There was no statistical difference in VAS 2 and 24 h after surgery between 2 groups ( P>0.05). The rates of general anesthesia and postoperative remedial analgesia in observation group were significantly lower than those in control group: 0 vs. 33.3% (10/30) and 6.7% (2/30) vs. 83.3% (25/30), and there were statistical differences ( P<0.05). There was no significant difference in the incidence of nausea and vomiting between 2 groups ( P>0.05). There were no local anesthetic poisoning, accidental intraperitoneal injection, cardiovascular and cerebrovascular accident in 2 groups. Conclusions:Compared with local infiltration anesthesia, ultrasound-guided double TAPB under regional anesthesia and sedation can provide complete intraoperative and postoperative analgesia during inguinal hernia repair in elderly patients, with more stable hemodynamics and better comfort.