Sujatha Chinthavali, Zachariah Mamie, Ranjan R V, George Sagiev Koshy, Ramachandran T R, Pillai Anil Radhakrishna
Department of Anesthesia, Pondicherry Institute of Medical Sciences, Puducherry, India.
Anesth Essays Res. 2017 Oct-Dec;11(4):976-980. doi: 10.4103/aer.AER_33_17.
Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery. In this randomized clinical trial, we have compared the analgesic efficacy of transversus abdominis plane (TAP) block with that of ilioinguinal/iliohypogastric (IIIH) nerve block with wound infiltration in patients undergoing unilateral open inguinal hernia repair.
The primary objective of this study was to compare the efficacy of postoperative analgesia of ultrasound-guided TAP block and IIIH block with wound infiltration (WI) in patients undergoing open inguinal hernia surgery.
This was a randomized clinical trial performed in a tertiary care hospital.
Sixty patients scheduled for hernia repair were randomized into two groups, Group T and Group I. Postoperatively, under ultrasound guidance, Group T received 20 ml of 0.25% ropivacaine - TAP block and Group I received 10 ml of 0.25% ropivacaine - IIIH block + WI with 10 ml of 0.25% ropivacaine. The primary outcome measure was the time to rescue analgesia in the first 24 h postoperatively. Fentanyl along with diclofenac was given as first rescue analgesic when the patient complained of pain.
Statistical comparisons were performed using Student's -test and Chi-square test.
Mean time to rescue analgesia was 5.900 ± 1.881 h and 3.766 ± 1.754 h ( < 0.001) and the mean pain scores were 5.73 ± 0.784 and 6.03 ± 0.850 for Group TAP and IIIH + WI, respectively. Hemodynamics were stable in both the groups. One-third of the patients received one dose of paracetamol in addition to the rescue analgesic in the first 24 h. There were no complications attributed to the block.
As a multimodal analgesic regimen, definitely both TAP block and IIIH block with wound infiltration have a supporting role in providing analgesia in the postoperative period for adult inguinal hernia repair. In this study, ultrasound-guided TAP block provided longer pain control postoperatively than IIIH block with WI after inguinal hernia repair. There were no complications attributed to the blocks in either of the group.
腹股沟疝修补术患者术后镇痛采用了多种镇痛方式。在这项随机临床试验中，我们比较了腹横肌平面（TAP）阻滞与髂腹股沟/髂腹下神经（IIIH）阻滞联合伤口浸润在单侧开放性腹股沟疝修补术患者中的镇痛效果。
本研究的主要目的是比较超声引导下TAP阻滞与IIIH阻滞联合伤口浸润（WI）在开放性腹股沟疝修补术患者中的术后镇痛效果。
这是一项在三级医疗中心进行的随机临床试验。
60例计划行疝修补术的患者随机分为两组，T组和I组。术后，在超声引导下，T组接受20 ml 0.25%罗哌卡因——TAP阻滞，I组接受10 ml 0.25%罗哌卡因——IIIH阻滞 + 10 ml 0.25%罗哌卡因伤口浸润。主要观察指标是术后24小时内需要补救镇痛的时间。当患者主诉疼痛时，给予芬太尼联合双氯芬酸作为首次补救镇痛药。
采用Student's -检验和卡方检验进行统计比较。
TAP组和IIIH + WI组需要补救镇痛的平均时间分别为5.900 ± 1.881小时和3.766 ± 1.754小时（P < 0.001），平均疼痛评分分别为5.73 ± 0.784和6.03 ± 0.850。两组血流动力学均稳定。三分之一的患者在术后24小时内除了补救镇痛药外还接受了一剂对乙酰氨基酚。未出现与阻滞相关的并发症。
作为一种多模式镇痛方案，TAP阻滞和IIIH阻滞联合伤口浸润在成人腹股沟疝修补术后镇痛中均有辅助作用。在本研究中，超声引导下的TAP阻滞在腹股沟疝修补术后提供的疼痛控制时间比IIIH阻滞联合WI更长。两组均未出现与阻滞相关的并发症。
