Okur Onur, Tekgul Zeki Tuncel, Erkan Nazif
Department of Anesthesiology and Reanimation, Izmir Bozyaka Training and Research Hospital, Bahar Mh. Saim Cikrikci St no: 59, Karabaglar, 35170, Izmir, Turkey.
Department of General Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
J Anesth. 2017 Oct;31(5):678-685. doi: 10.1007/s00540-017-2378-3. Epub 2017 Jun 14.
The purpose of this study was to compare the effects of lateral abdominal transversus abdominis plane block (TAP block) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance for postoperative pain management of inguinal hernia repair. Secondary purposes were to compare the complication rates of the two techniques and to examine the effects of TAP block and IHINB on chronic postoperative pain.
This was a prospective randomized controlled open-label study. After approval of the Research Ethics Board, a total of 90 patients were allocated to three groups of 30 by simple randomized sampling as determined with a priori power analysis. Peripheral nerve blocks (TAP block or IHINB) were administered to patients following subarachnoid block according to their allocated group. Patient pain scores, additional analgesic requirements and complication rates were recorded periodically and compared.
Pain scores were significantly lower in the study groups (p < 0.001, p < 0.001, p < 0.001, p = 0.002, p < 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h and at 1 and 6 months, respectively). First pain declaration times were significantly longer in the study groups (TAP block group [GT] 266.6 ± 119.7 min; IHINB group [GI] 247.2 ± 128.7 min; and control group [GC] 79.1 ± 66.2 min; p < 0.001). At 24 h, the numeric rating scale scores of GT were significantly lower than GI (p = 0.048). Additional analgesic requirements of GT and GI patients were found to be significantly lower than GC patients (p = 0.001, p < 0.001, p = 0.006, p = 0.002, p = 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h, respectively).
We conclude that administration of TAP block or IHINB for patients undergoing inguinal herniorrhaphy reduces the intensity of both acute and chronic postoperative pain and additional analgesic requirements.
本研究旨在比较超声引导下侧方腹横肌平面阻滞（TAP阻滞）和髂腹下/髂腹股沟神经阻滞（IHINB）对腹股沟疝修补术后疼痛管理的效果。次要目的是比较两种技术的并发症发生率，并研究TAP阻滞和IHINB对术后慢性疼痛的影响。
这是一项前瞻性随机对照开放标签研究。经研究伦理委员会批准，根据先验功效分析，通过简单随机抽样将90例患者分为3组，每组30例。根据分配的组，在蛛网膜下腔阻滞术后对患者进行周围神经阻滞（TAP阻滞或IHINB）。定期记录并比较患者的疼痛评分、额外镇痛需求和并发症发生率。
研究组的疼痛评分显著更低（分别在术后1、2、4、6、24和48小时以及1和6个月时，p<0.001、p<0.001、p<0.001、p=0.002、p<0.001、p<0.001）。研究组首次疼痛声明时间显著更长（TAP阻滞组[GT]266.6±119.7分钟；IHINB组[GI]247.2±128.7分钟；对照组[GC]79.1±66.2分钟；p<0.001）。在24小时时，GT组的数字评分量表得分显著低于GI组（p=0.048）。发现GT组和GI组患者的额外镇痛需求显著低于GC组患者（分别在术后1、2、4、6、24和48小时时，p=0.001、p<0.001、p=0.006、p=0.002、p=0.001、p<0.001）。
我们得出结论，对接受腹股沟疝修补术的患者进行TAP阻滞或IHINB可降低急性和慢性术后疼痛的强度以及额外镇痛需求。
