Weltz Christina R, Klein Stephen M, Arbo John E, Greengrass Roy A
Department of Surgery, Mount Sinai Medical Center, 5 East 98th Street, Box 1259, New York, New York 10029, USA.
World J Surg. 2003 Apr;27(4):425-9. doi: 10.1007/s00268-002-6661-5.
Choice of anesthesia for inguinal hernia repair remains a controversial topic. Local anesthesia has been described in the literature as the optimal technique, however general and spinal anesthesia are commonly used in practice despite well-known complications and side effects. The regional technique of paravertebral block has been successfully used at our institution for the operative treatment of breast cancer. Its attributes are prolonged sensory block with minimization of postoperative pain, reduction of nausea and vomiting, shortened hospital stay, patient satisfaction, and rapid return to normal activities. These features are desirable in the practice of ambulatory hernia surgery; hence we initiated the use of thoracic/lumbar paravertebral block for that surgical procedure. Paravertebral block anesthesia was performed on 30 consecutive patients. Block placement took an average of 12.3 minutes, in six cases repeat injection at one or two spinal levels was required due to incomplete blockade. Paravertebral block achieved effective anesthesia in 28 of 30 cases; conversion to general anesthesia was performed for two failed blocks. We are reporting postoperative data on the 28 completed blocks. Supplementation of intravenous sedation or injection of local anesthesia successfully treated transient intraoperative pain in 10 cases. Epidural extension of anesthesia resulting in lower limb numbness and motor weakness delayed the discharge of two patients. There were no other complications of anesthesia and no cases of urinary retention. TIme to onset of pain averaged 15 hours, while duration of sensory block was 13 hours. Patients were prescribed a standing order of naproxen 500 mg B.I.D. for 4 days regardless of pain; supplemental oral narcotic use during the 48 hours following surgery averaged 3.5 tablets, with 6 patients not requiring any narcotic. ninety-six percent of patients scheduled for ambulatory surgery were discharged from the postanesthesia care unit, with an average stay of 2.5 hours. Employed patients returned to work on day 5.5 (range 3-10 days); patients who were not employed returned to regular activities in 5.8 days (range 1-14 days). Eighty-two percent of patients reported being "very satisfied" with the anesthetic technique.
腹股沟疝修补术的麻醉选择仍然是一个有争议的话题。局部麻醉在文献中被描述为最佳技术，然而，尽管全身麻醉和脊髓麻醉存在众所周知的并发症和副作用，但在实际操作中仍被广泛使用。椎旁阻滞这一区域技术已在我们机构成功用于乳腺癌的手术治疗。其特点是感觉阻滞时间延长，术后疼痛最小化，恶心和呕吐减少，住院时间缩短，患者满意度高，且能快速恢复正常活动。这些特点在门诊疝手术中是可取的；因此，我们开始将胸段/腰段椎旁阻滞用于该手术。对30例连续患者实施了椎旁阻滞麻醉。阻滞放置平均耗时12.3分钟，6例因阻滞不完全需要在一个或两个脊髓节段重复注射。30例中有28例椎旁阻滞实现了有效麻醉；2例阻滞失败后转为全身麻醉。我们报告了28例完成阻滞的术后数据。10例患者通过补充静脉镇静或注射局部麻醉成功处理了术中短暂疼痛。麻醉向硬膜外扩散导致下肢麻木和运动无力，使2例患者出院延迟。没有其他麻醉并发症，也没有尿潴留病例。疼痛开始时间平均为15小时，感觉阻滞持续时间为13小时。无论疼痛情况如何，均为患者开具了4天的萘普生500毫克每日两次的长期医嘱；术后48小时内口服补充麻醉药的用量平均为3.5片，6例患者不需要任何麻醉药。计划进行门诊手术的患者中有96%从麻醉后护理单元出院，平均停留时间为2.5小时。有工作的患者在第5.5天（范围3 - 10天）返回工作岗位；无工作的患者在5.8天（范围1 - 14天）恢复正常活动。82%的患者表示对麻醉技术“非常满意”。
