Bojaxhi E, Lee J, Bowers S, Frank R D, Pak S H, Rosales A, Padron S, Greengrass R A
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
Department of Anesthesiology, Good Samaritan Hospital, Mount Vernon, IL, USA.
Hernia. 2018 Oct;22(5):871-879. doi: 10.1007/s10029-018-1792-2. Epub 2018 Jun 16.
Inguinal hernia repair and general anesthesia (GA) are known risk factors for urinary retention. Paravertebral blocks (PVBs) have been utilized to facilitate enhanced recovery after surgery. We evaluate the benefit of incorporating PVBs into our anesthetic technique in a large cohort of ambulatory patients undergoing inguinal hernia repair.
Records of 619 adults scheduled for ambulatory inguinal hernia repair between 2010 and 2015 were reviewed and categorized based on anesthetic and surgical approach [GA and open (GAO), GA and laparoscopic (GAL), PVB and open (PVBO), and GA/PVB and open (GA/PVBO)]. Patients were excluded for missing data, self-catheterization, chronic opioid tolerance, and additional surgical procedures coinciding with hernia repair. Risk factors associated with the primary outcome of urinary retention were examined using logistic regression.
PVBO (n = 136) had significantly lower odds than GAO of experiencing urinary retention (odds ratio 0.16; 95% CI 0.05-0.51); overall (P < .01), with 4.4% (n = 6) of the patients in the PVBO group having urinary retention versus 22.6% (n = 7) with GAO. Expressed as intravenous morphine equivalences, the PVBO group had the lowest median opioid use (5 mg), followed by GA, PVB, and open (7.5 mg); GAO 25 mg; and GAL 25 mg. Also, 30% (n = 41) of the PVBO group required no opioid analgesia in the postanesthesia care unit.
PVBs as the primary anesthetic or an adjunct to GA is the preferred anesthetic technique for open inguinal hernia repair as it facilitates enhanced recovery after surgery by decreasing risk of urinary retention, opioid requirements, and length of stay.
腹股沟疝修补术和全身麻醉（GA）是已知的尿潴留危险因素。椎旁阻滞（PVB）已被用于促进术后恢复。我们评估了在一大群接受腹股沟疝修补术的门诊患者中，将PVB纳入麻醉技术的益处。
回顾了2010年至2015年间计划进行门诊腹股沟疝修补术的619例成人患者的记录，并根据麻醉和手术方法[GA和开放手术（GAO）、GA和腹腔镜手术（GAL）、PVB和开放手术（PVBO）以及GA/PVB和开放手术（GA/PVBO）]进行分类。因数据缺失、自我导尿、慢性阿片类药物耐受性以及与疝修补术同时进行的其他外科手术而排除患者。使用逻辑回归分析与尿潴留主要结局相关的危险因素。
PVBO组（n = 136）发生尿潴留的几率显著低于GAO组（比值比0.16；95%可信区间0.05 - 0.51）；总体而言（P < 0.01），PVBO组4.4%（n = 6）的患者发生尿潴留，而GAO组为22.6%（n = 7）。以静脉注射吗啡等效剂量表示，PVBO组的阿片类药物使用中位数最低（5毫克），其次是GA、PVB和开放手术组（7.5毫克）；GAO组为25毫克；GAL组为25毫克。此外，PVBO组30%（n = 41）的患者在麻醉后护理单元不需要阿片类镇痛。
PVB作为主要麻醉方法或GA的辅助方法是开放腹股沟疝修补术的首选麻醉技术，因为它通过降低尿潴留风险、阿片类药物需求和住院时间来促进术后恢复。
