Kamal Kirti, Jain Parul, Bansal Teena, Ahlawat Geeta
Department of Anaesthesiology and Critical Care, University of Health Sciences, Rohtak, Haryana, India.
Indian J Anaesth. 2018 Apr;62(4):292-297. doi: 10.4103/ija.IJA_548_17.
Both transversus abdominis plane (TAP) block and combined ilioinguinal-iliohypogastric (IIN/IHN) blocks are used routinely under ultrasound (USG) guidance for postoperative pain relief in patients undergoing inguinal hernia surgery. This study compares USG guided TAP Vs IIN/IHN block for post-operative analgesic efficacy in adults undergoing inguinal hernia surgery.
Sixty adults aged 18 to 60 with American Society of Anesthesiologsts' grade I or II were included. After general anaesthesia, patients in Group I received USG guided unilateral TAP block using 0.75% ropivacaine 3 mg/kg (maximum 25 mL) and those in Group II received IIN/IHN block using 10 mL 0.75% ropivacaine. Postoperative rescue analgesia was with tramadol (intravenous) IV ± diclofenac IV in the first 4 h followed by oral diclofenac subsequently. Total analgesic consumption in the first 24 h was the primary objective, intraoperative haemodynamics, number of attempts and time required for performing the block as well as the postoperative pain scores were also evaluated.
Time to first analgesic request was 319.8 ± 115.2 min in Group I and 408 ± 116.4 min in Group II ( = 0.005). Seven patients (23.33%) in Group I and two (6.67%) in Group II required tramadol in first four hours. No patient in either groups received diclofenac IV. The average dose of tablet diclofenac was 200 ± 35.96 mg in Group I and 172.5 ± 34.96 mg in Group II ( = 0. 004).
USG guided IIN/IHN block reduces the postoperative analgesic requirement compared to USG guided TAP block.
腹横肌平面（TAP）阻滞和联合髂腹股沟 - 髂腹下神经（IIN/IHN）阻滞在超声（USG）引导下常用于腹股沟疝修补术患者的术后镇痛。本研究比较了USG引导下TAP阻滞与IIN/IHN阻滞对腹股沟疝修补术成年患者术后镇痛效果的影响。
纳入60例年龄在18至60岁之间、美国麻醉医师协会分级为I或II级的成年人。全身麻醉后，第一组患者接受USG引导下的单侧TAP阻滞，使用0.75%罗哌卡因3mg/kg（最大25mL），第二组患者接受IIN/IHN阻滞，使用10mL 0.75%罗哌卡因。术后前4小时，使用曲马多（静脉注射）IV ± 双氯芬酸IV进行补救镇痛，随后口服双氯芬酸。首要观察指标为前24小时的总镇痛药物消耗量，同时评估术中血流动力学、阻滞操作的尝试次数和所需时间以及术后疼痛评分。
第一组患者首次需要镇痛的时间为319.8 ± 115.2分钟，第二组为408 ± 116.4分钟（P = 0.005）。第一组有7例患者（23.33%）在前4小时需要使用曲马多，第二组有2例患者（6.67%）需要使用。两组均无患者接受双氯芬酸IV。第一组双氯芬酸片剂的平均剂量为200 ± 35.96mg，第二组为172.5 ± 34.96mg（P = 0.004）。
与USG引导下的TAP阻滞相比，USG引导下的IIN/IHN阻滞可减少术后镇痛药物的需求。
