Klein Stephen M, Pietrobon Ricardo, Nielsen Karen C, Steele Susan M, Warner David S, Moylan Joseph A, Eubanks W Steve, Greengrass Roy A
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Reg Anesth Pain Med. 2002 Sep-Oct;27(5):476-80. doi: 10.1053/rapm.2002.35147.
Inguinal herniorrhaphy (IH) is a common outpatient procedure, yet postoperative pain and anesthetic side effects remain a problem. Paravertebral somatic nerve blocks (PVB) have the potential to offer unilateral abdominal wall anesthesia and long-lasting pain relief with minimal side effects. We compared PVB with peripheral neural blocks for outpatient IH.
Forty-six patients scheduled for IH were entered into this prospective, single-blind study. All patients underwent a standardized general anesthetic. Patients were randomly assigned to receive a PVB (levels T10-L2) preoperatively (n = 24) or an intraoperative peripheral block (PB) by the surgeon (n = 22), using 0.5% ropivacaine (40 mL). Opioid use, verbal analog pain scores, and side effects were documented for 72 hours.
The use of opioids during surgery was less for the PVB group 162 +/- 70 mg than the PB group, 210 +/- 60 (P =.02). Need for opioids in PACU was less for the PVB group (39%) than the PB group (61%) (P =.002). Time until first pain after discharge was not different between groups, 312 +/- 446 minutes (PB) and 425 +/- 384 minutes (PVB) (P =.12). Of the PVB patients, 29% used no opioids at all compared with 18% of PB patients (P =.12). Mean time until first oxycodone use was similar between groups, 303 +/- 469 minutes (PB) and 295 +/- 225 minutes (PVB) (P =.18). Oxycodone use was also similar; 35 +/- 34 mg (PVB) versus 49 +/- 42 mg (PB) (P =.30). More patients in the PB group (50%) required antiemetic treatment in the postanesthesia care unit than the PVB group (21%) (P <.001). Side effects were similar at all other measurements.
This study shows that PVB provides analgesia equivalent to extensive peripheral nerve block for inguinal herniorrhaphy, offering an alternative method of postoperative pain management and perhaps fewer side effects.
腹股沟疝修补术（IH）是一种常见的门诊手术，但术后疼痛和麻醉副作用仍然是个问题。椎旁体神经阻滞（PVB）有可能提供单侧腹壁麻醉，并以最小的副作用实现持久的疼痛缓解。我们比较了PVB与外周神经阻滞用于门诊腹股沟疝修补术的效果。
46例计划行腹股沟疝修补术的患者纳入了这项前瞻性单盲研究。所有患者均接受标准化全身麻醉。患者被随机分配在术前接受PVB（T10-L2节段）（n = 24）或由外科医生在术中进行外周阻滞（PB）（n = 22），使用0.5%罗哌卡因（40 mL）。记录72小时内的阿片类药物使用情况、视觉模拟疼痛评分和副作用。
PVB组手术期间阿片类药物的使用量为162±70 mg，低于PB组的210±60 mg（P = 0.02）。PVB组在麻醉后恢复室（PACU）对阿片类药物的需求低于PB组（39%对61%）（P = 0.002）。出院后至首次疼痛的时间在两组之间无差异，PB组为312±446分钟，PVB组为425±384分钟（P = 0.12）。PVB组中29%的患者根本未使用阿片类药物，而PB组为18%（P = 0.12）。两组至首次使用羟考酮的平均时间相似，PB组为303±469分钟，PVB组为295±225分钟（P = 0.18）。羟考酮的使用量也相似；PVB组为35±34 mg，PB组为49±42 mg（P = 0.30）。PB组更多患者（50%）在麻醉后护理单元需要使用止吐治疗，而PVB组为21%（P < 0.001）。在所有其他测量指标中，副作用相似。
本研究表明，对于腹股沟疝修补术，PVB提供的镇痛效果与广泛的外周神经阻滞相当，为术后疼痛管理提供了一种替代方法，并可能减少副作用。
