髂腹股沟/髂腹下神经阻滞与竖脊肌平面阻滞用于择期开放腹股沟疝修补术的比较：一项前瞻性、随机、双盲、等效性试验。
Ilioinguinal/Iliohypogastric versus quadratus lumborum nerve blockade for elective open inguinal herniorrhaphy: a prospective, randomized, double-blinded, equivalency trial.
机构信息
Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
出版信息
Reg Anesth Pain Med. 2020 Dec;45(12):970-974. doi: 10.1136/rapm-2020-101571. Epub 2020 Oct 1.
BACKGROUND
Open inguinal herniorrhaphy (OIH) is a commonly performed surgical procedure with expected postoperative pain. Historically, an option for regional analgesia has been an ilioinguinal and iliohypogastric nerve block (IINB). More recently, the transmuscular quadratus lumborum block (QLB) has been used as an analgesic technique for a variety of abdominal and truncal surgical procedures. Given our own institutional experiences with the performance of QLB combined with the body of literature supporting the proximal blockade of the ilioinguinal and iliohypogastric nerves via this approach, we compared the analgesia provided by an IINB to a QLB. We hypothesized that the two blocks would provide equivalent analgesia, as defined by a difference of less than±2 points on the pain scale (0-10 numeric rating scale (NRS)), for patients undergoing OIH.
METHODS
Sixty patients scheduled for elective outpatient OIH under general anesthesia were randomized to preoperatively receive either an IINB or a transmuscular QLB with 0.25% bupivacaine/epinephrine/clonidine for postoperative analgesia. The primary endpoint was movement NRS pain scores at 8 hours. Secondary outcomes included resting NRS pain scores at 8 and 24 hours, movement NRS pain scores at 24 hours, incidence of opioid related side effects (nausea, vomiting, pruritus), time-to-first oral opioid analgesic, and total opioid consumption at 24 hours.
RESULTS
Fifty-nine patients were analyzed per an intention-to-treat approach (one patient was excluded because the surgical procedure was canceled). Movement pain scores at 8 hours were equivalent (IINB 5.10±3.02 vs QLB 5.03±3.01 (mean NRS±SD); two one-sided test mean difference (90% CI), 0.07 (-1.24 to 1.38), p ≤0.01). There were no differences between groups for any of the secondary endpoints.
CONCLUSION
An IINB and a transmuscular QLB are equivalent with regards to their ability to provide postoperative analgesia after OIH.
背景
开放式腹股沟疝修补术（OIH）是一种常见的手术，术后会有预期的疼痛。历史上，区域镇痛的一种选择是髂腹股沟和髂腹下神经阻滞（IINB）。最近，经腹直肌外侧缘肌间沟阻滞（QLB）已被用作多种腹部和躯干手术的镇痛技术。鉴于我们自己在 QLB 操作方面的经验，以及支持通过这种方法对髂腹股沟和髂腹下神经进行近端阻滞的文献，我们比较了 IINB 和 QLB 提供的镇痛效果。我们假设，在接受 OIH 的患者中，两种阻滞方式的镇痛效果相当，定义为疼痛评分差值小于±2 分（0-10 数字评分量表（NRS））。
方法
60 例在全身麻醉下择期行 OIH 的患者被随机分为两组，术前分别接受 IINB 或经腹直肌外侧缘肌间沟阻滞（0.25%布比卡因/肾上腺素/可乐定）进行术后镇痛。主要终点是 8 小时时的运动 NRS 疼痛评分。次要结局包括 8 小时和 24 小时时的静息 NRS 疼痛评分、24 小时时的运动 NRS 疼痛评分、阿片类药物相关副作用（恶心、呕吐、瘙痒）的发生率、首次口服阿片类药物镇痛的时间和 24 小时时的总阿片类药物消耗量。
结果
按意向治疗方法分析了 59 例患者（1 例患者因手术取消而被排除）。8 小时时的运动疼痛评分相当（IINB 5.10±3.02 与 QLB 5.03±3.01（均值 NRS±SD）；双侧单边检验均值差值（90%CI）为 0.07（-1.24 至 1.38），p≤0.01）。两组在任何次要结局上均无差异。
结论
在 OIH 后提供术后镇痛方面，IINB 和经腹直肌外侧缘肌间沟阻滞的效果相当。
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