Ankara Numune Research and Training Hospital, Department of Anesthesiology and Resuscitation, Ankara, Turkey.
Minerva Anestesiol. 2009 Dec;75(12):684-91.
Inguinal herniorrhaphy (IH) is a common surgical procedure that can be successfully performed by using general, regional or local anesthesia and is usually performed in an outpatient setting. In this study, recovery profile, incidence of adverse effects, postoperative pain scores and patient satisfaction between paravertebral block (PVB) and spinal anesthesia (SA) for fast track ambulatory IH were compared.
Sixty patients were randomly assigned to receive either PVB or unilateral SA under standardized protocols (PVB at T9-L1 levels with 5 mL of 0.5 % levobupivacaine for each, unilateral SA at L2-L3 level with 8 mg 0.5% hyperbaric levobupivacaine). All patients were sedated with propofol, 10-70 mg.kg.min. Data on anesthesia, surgery and PACU times, hemodynamic changes, home readiness, pain, and incidence of adverse effects were recorded.
One block failed in the PVB group. Anesthesia-related time and onset time were longer in the PVB group, but phase 1 PACU time, time to home-readiness with and without voiding and actual discharge time were significantly shorter in the PVB group. Although the fast-tracking rate was higher in the PVB group, this difference was not significant. The mean propofol dose was higher in the PVB group (52.03+/-19.32 [35-73] mg x kg x min-1) than in the SA group (44.0+/-18.8 [33-70] mg x kg x min-1) (P=0.002). VAS scores at 4, 6 and 12 hours were significantly lower in the PVB group, both at rest and during movement. VAS scores at 30, 60, 120, 180 min and at 18, 24 and 48 hours were comparable in the two groups. Duration of sensory block, onset time of discomfort, time to first analgesic, and time to first rescue analgesic were longer in the PVB group.
In ambulatory IH, PVB provided shorter home readiness time, long lasting postoperative analgesia and improved quality of recovery, and could be a good alternative to SA.
腹股沟疝修补术（IH）是一种常见的外科手术，可以在全身麻醉、区域麻醉或局部麻醉下成功进行，通常在门诊环境下进行。本研究比较了椎旁阻滞（PVB）和脊髓麻醉（SA）在快速通道日间腹股沟疝修补术中的恢复情况、不良反应发生率、术后疼痛评分和患者满意度。
60 名患者随机分为接受 PVB 或单侧 SA 组（PVB 在 T9-L1 水平，每侧 5 毫升 0.5%左旋布比卡因；单侧 SA 在 L2-L3 水平，每侧 8 毫克 0.5%超比重左旋布比卡因）。所有患者均接受异丙酚镇静，剂量为 10-70mg/kg/min。记录麻醉、手术和 PACU 时间、血液动力学变化、出院准备情况、疼痛和不良反应发生率。
PVB 组有 1 例阻滞失败。PVB 组麻醉相关时间和起效时间较长，但 PVB 组 PACU 第 1 期时间、有或无排尿时出院准备时间和实际出院时间明显缩短。虽然 PVB 组快速跟踪率较高，但差异无统计学意义。PVB 组异丙酚剂量（52.03+/-19.32[35-73]mg x kg x min-1）高于 SA 组（44.0+/-18.8[33-70]mg x kg x min-1）（P=0.002）。PVB 组在 4、6 和 12 小时的 VAS 评分均显著低于 SA 组，无论在休息时还是运动时。两组在 30、60、120、180 分钟和 18、24 和 48 小时的 VAS 评分无差异。PVB 组感觉阻滞持续时间、不适出现时间、首次镇痛时间和首次解救镇痛时间较长。
在日间 IH 中，PVB 可缩短出院准备时间，提供持久的术后镇痛，改善恢复质量，可作为 SA 的替代方法。
