Kwon Woojin, Bang Seunguk, Soh Hyojung, Jeong Won Jun, Lee Sang Chul, Choi Byung Jo
Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul Department of Surgery, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.
Medicine (Baltimore). 2018 Jun;97(24):e10964. doi: 10.1097/MD.0000000000010964.
Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is a rapidly evolving, minimally invasive treatment modality for inguinal hernia. Compared with open hernia repair, this method requires a smaller incision, has cosmetic advantages, and facilitates rapid recovery and early return to daily activities because of less postoperative pain. Because general anesthesia is essential for TEP hernia repair, it cannot be performed on patients who have an increased risk of developing complications when placed under general anesthesia.
We report 2 cases of single-port laparoscopic TEP (SP TEP) that were performed using only an abdominal peripheral nerve block (PNB) at our institute. General anesthesia and neuraxial block were dangerous for both patients owing to severe heart failure and severe chronic obstructive pulmonary disease (COPD).
They were diagnosed with an inguinal hernia requiring surgery.
Hence, the anesthesiologist and surgeon decided to attempt a PNB to avoid complications from general anesthesia and allow faster recovery. An ipsilateral transversus abdominis plane block as well as a rectus sheath block and inguinal canal block were administered via ultrasound guidance.
The patients did not report any pain, and no rescue drug was administrated. The operation times were 65 and 62minutes in patients 1 and 2, respectively. No intraoperative complications were noted. Patient 1 was discharged the day after the surgery, whereas patient 2 was discharged on the same day as the surgery.
TEP hernia repair using abdominal PNB anesthesia seemed to be a safe and feasible technique without causing any additional complications. However, the use of abdominal PNB anesthesia alone for TEP hernia repair as an alternative to general anesthesia requires further investigation using a larger cohort.
腹腔镜完全腹膜外（TEP）腹股沟疝修补术是一种快速发展的腹股沟疝微创治疗方式。与开放疝修补术相比，该方法切口更小，具有美容优势，且由于术后疼痛较轻，有利于快速恢复和早日恢复日常活动。由于全身麻醉是TEP疝修补术必不可少的，因此不能对全身麻醉时发生并发症风险增加的患者进行该手术。
我们报告了在我院进行的2例单孔腹腔镜TEP（SP TEP）手术，仅使用了腹部外周神经阻滞（PNB）。由于严重心力衰竭和严重慢性阻塞性肺疾病（COPD），全身麻醉和神经轴阻滞对这两名患者均有危险。
他们被诊断为需要手术的腹股沟疝。
因此，麻醉医生和外科医生决定尝试进行PNB，以避免全身麻醉的并发症并加快恢复。通过超声引导实施了同侧腹横肌平面阻滞以及腹直肌鞘阻滞和腹股沟管阻滞。
患者均未报告任何疼痛，也未使用抢救药物。患者1和患者2的手术时间分别为65分钟和62分钟。未观察到术中并发症。患者1术后次日出院，而患者2在手术当天出院。
使用腹部PNB麻醉进行TEP疝修补术似乎是一种安全可行的技术，不会引起任何额外并发症。然而，仅使用腹部PNB麻醉作为全身麻醉的替代方法进行TEP疝修补术，需要使用更大的队列进行进一步研究。
