Mandal M C, Das S, Gupta Sunil, Ghosh T R, Basu S R
Department of Anaesthesiology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India.
Indian J Anaesth. 2011 Nov;55(6):584-9. doi: 10.4103/0019-5049.90613.
Inguinal hernia repair can be performed under satisfactory anaesthetic conditions using general, regional and peripheral nerve block anaesthesia. Unilateral spinal anaesthesia provides optimal anaesthesia, with stable haemodynamics and minimal adverse events. The paravertebral block, being segmental in nature, can be expected to produce some advantages regarding haemodynamic stability and early ambulation and may be a viable alternative.
Fifty-four consenting male patients posted for inguinal hernia repair were randomized into two groups, to receive either the two-segment paravertebral block (group-P, n=26) at T10 and L1 or unilateral spinal anaesthesia (group-S, n=28), respectively. The time to ambulation (primary outcome), time to the first analgesic, total rescue analgesic consumption in the first 24-hour period and adverse events were noted.
Block performance time and time to reach surgical anaesthesia were significantly higher in the patients of group-P (P<0.001). Time to ambulation was significantly shorter in group-P compared to group-S (P<0.001), while postoperative sensory block was prolonged in patients of group-S; P<0.001. A significantly higher number of patients could bypass the recovery room in group-P compared to group-S, (45% versus 0%, respectively, P<0.001). No statistically significant difference in adverse outcomes was recorded.
Both the paravertebral block and unilateral spinal anaesthesia are effective anaesthetic techniques for uncomplicated inguinal hernia repair. However, the paravertebral block can be an attractive alternative as it provides early ambulation and prolonged postoperative analgesia with minimal adverse events.
腹股沟疝修补术可在全身麻醉、区域麻醉和周围神经阻滞麻醉等令人满意的麻醉条件下进行。单侧脊髓麻醉可提供最佳麻醉效果，血流动力学稳定且不良事件最少。椎旁阻滞本质上是节段性的，在血流动力学稳定性和早期活动方面可能具有一些优势，可能是一种可行的替代方法。
54名同意接受腹股沟疝修补术的男性患者被随机分为两组，分别在T10和L1接受两段式椎旁阻滞（P组，n = 26）或单侧脊髓麻醉（S组，n = 28）。记录患者的活动时间（主要结局）、首次使用镇痛药的时间、术后24小时内的总补救镇痛药消耗量以及不良事件。
P组患者的阻滞操作时间和达到手术麻醉的时间明显更长（P < 0.001）。与S组相比，P组患者的活动时间明显更短（P < 0.001），而S组患者的术后感觉阻滞时间延长；P < 0.001。与S组相比，P组能够绕过恢复室的患者数量明显更多（分别为45%和0%，P < 0.001）。不良结局方面未记录到统计学上的显著差异。
椎旁阻滞和单侧脊髓麻醉都是用于简单腹股沟疝修补术的有效麻醉技术。然而，椎旁阻滞可能是一种有吸引力的替代方法，因为它能实现早期活动并提供术后长时间镇痛，且不良事件最少。
