Unit of Obstetrics and Day Surgery Anesthesia, Department of Anesthesiology, Reanimation, Intensive Care, and Pain Therapy, A. Gemelli University Hospital Foundation, Sacro Cuore Catholic University, Rome, Italy -
Unit of Obstetrics and Day Surgery Anesthesia, Department of Anesthesiology, Reanimation, Intensive Care, and Pain Therapy, A. Gemelli University Hospital Foundation, Sacro Cuore Catholic University, Rome, Italy.
Minerva Anestesiol. 2018 Feb;84(2):189-195. doi: 10.23736/S0375-9393.17.11948-6. Epub 2017 Jul 5.
Ultrasound-guided (USG) ilioinguinal/iliohypogastric nerve (II/IHN) block is a widely validated anesthetic technique for inguinal herniorrhaphy. As the spermatic cord, scrotum, and adjacent thigh receive sensory innervation from the genital branch of genitofemoral nerve (GFN), the addition of GFN block has been suggested to improve the quality of perioperative anesthesia and analgesia. The aim of this study is to compare GFN block plus II/IHN block with II/IHN block alone for intraoperative anesthesia and post-operative pain management.
We enrolled 80, ASA I-III, male adults scheduled for elective open herniorrhaphy. Patients were randomized to receive either USG II/IHN plus GFN block (Case Group) or USG II/IHN block alone (Control Group). The outcome measures were the assessment of postoperative VAS scores on coughing and the adequacy of anesthesia, measured with intraoperative requirement for extra local anesthetic (LA) infiltration and number of patients needing systemic sedation.
The requirement of intraoperative additional doses of LA was significantly lower in the Case Group (median LA volume administered by the surgeon: 13.8±5.6 mL vs. 20.7±9.1 mL, P<0.05). Two patients in the Control Group needed systemic sedation. VAS scores at 15 minutes, 30 minutes, 1 hour, 2 hours, pre-discharge, and 24 hours were significantly lower in the Case Group (P<0.005). Four cases of femoral nerve block were reported, three in the Control Group, one in the Case Group (2.2% vs. 7.7%, P>0.05).
The combination of GFN block and II/IHN block is associated with lower postoperative VAS scores and lower doses of intraoperative additional LA.
超声引导下（USG）髂腹股沟/髂腹下神经（II/IHN）阻滞是一种广泛验证的腹股沟疝修补术麻醉技术。由于精索、阴囊和邻近大腿接受生殖股神经（GFN）生殖器分支的感觉神经支配，因此建议加入 GFN 阻滞以改善围手术期麻醉和镇痛质量。本研究旨在比较 GFN 阻滞加 II/IHN 阻滞与单独 II/IHN 阻滞在术中麻醉和术后疼痛管理方面的效果。
我们纳入了 80 名 ASA I-III 级男性成年患者，计划行择期开放疝修补术。患者随机分为接受 USG II/IHN 加 GFN 阻滞（病例组）或 USG II/IHN 阻滞单独（对照组）。观察指标为咳嗽时术后 VAS 评分和麻醉效果的评估，通过术中需要额外局部麻醉（LA）浸润的次数和需要全身镇静的患者数量来衡量。
病例组术中需要额外局部麻醉的次数明显减少（手术医生给予的 LA 体积中位数：13.8±5.6 mL 比 20.7±9.1 mL，P<0.05）。对照组中有 2 名患者需要全身镇静。病例组在 15 分钟、30 分钟、1 小时、2 小时、出院前和 24 小时的 VAS 评分明显较低（P<0.005）。报告了 4 例股神经阻滞，对照组 3 例，病例组 1 例（2.2%比 7.7%，P>0.05）。
GFN 阻滞和 II/IHN 阻滞联合应用可降低术后 VAS 评分和术中额外 LA 的使用剂量。
