Işıl Canan Tülay, Çınar Ayşe Surhan Özer, Oba Sibel, Işıl Rıza Gürhan
Clinic of Anaesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
Turk J Anaesthesiol Reanim. 2014 Oct;42(5):257-63. doi: 10.5152/TJAR.2014.75508. Epub 2014 Jul 9.
We aimed to compare the efficacy of spinal anaesthesia (SA) and paravertebral block (PVB) in unilateral inguinal hernia repair.
Sixty American Society of Anesthesia physical status (ASA) I-III patients aged between 18-64 years with unilateral inguinal hernia were enrolled in this study. Two patients in Group SA and 4 patients in Group PVB were excluded, and statistical analyses were done on 54 patients. In regard to anaesthetic choice, patients were divided into two groups, with 30 patients in each: Group SA, spinal anaesthesia and Group PVB, paravertebral block. Standard monitoring was done, and mean arterial pressure (MAP) and heart rate (HR) were recorded during the surgical procedure. Demographic variables, surgical data, patient satisfaction, the onset times to reach T10 dermatome and to reach peak sensory level, and onset time to reach modified Bromage 3 motor block were recorded. Postoperative nausea and vomiting and pain at postoperative hours 0-24 with the visual analog scale (VAS) were also measured.
Compared to pre-anaesthesia measurements, the decrease in HR and MAP during the 10(th)-90(th) minute period was significant in Group SA (p<0.01). In Group PVB, sensory block duration time was higher, whereas paralysis rate was higher in Group SA (p<0.01). Bromage scores were significantly different between the groups (p<0.01). In Group SA, VAS score at the 24(th) postoperative hour, nausea, and vomiting were significantly higher compared to Group PVB (p<0.01).
In conclusion, paravertebral block provides acceptable surgical anaesthesia, maintaining good quality and long duration on postoperative analgesia in unilateral hernia repair.
我们旨在比较脊髓麻醉（SA）和椎旁阻滞（PVB）在单侧腹股沟疝修补术中的疗效。
本研究纳入了60例年龄在18 - 64岁之间、美国麻醉医师协会身体状况（ASA）分级为I - III级的单侧腹股沟疝患者。SA组排除2例患者，PVB组排除4例患者，对54例患者进行统计分析。在麻醉选择方面，患者被分为两组，每组30例：SA组，脊髓麻醉；PVB组，椎旁阻滞。进行标准监测，并在手术过程中记录平均动脉压（MAP）和心率（HR）。记录人口统计学变量、手术数据、患者满意度、达到T10皮节和达到感觉峰值水平的起效时间，以及达到改良Bromage 3级运动阻滞的起效时间。还测量了术后恶心呕吐情况以及术后0 - 24小时使用视觉模拟量表（VAS）评估的疼痛程度。
与麻醉前测量值相比，SA组在第10 - 90分钟期间HR和MAP的下降具有显著性（p<0.01）。在PVB组中，感觉阻滞持续时间更长，而SA组的麻痹率更高（p<0.01）。两组之间Bromage评分存在显著差异（p<0.01）。与PVB组相比，SA组术后第24小时的VAS评分、恶心和呕吐情况显著更高（p<0.01）。
总之，椎旁阻滞可提供可接受的手术麻醉，在单侧疝修补术中能保持良好的质量并具有较长时间的术后镇痛效果。
