Chen Tianwen, Li Mingying, Liu Yuchen, Zhang Xiaoxia, Sun Xiaoli, Li Jie, He Miao, Wang Zhenyuan
Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China.
Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China.
J Pain Res. 2025 Jan 1;18:1-10. doi: 10.2147/JPR.S481853. eCollection 2025.
To evaluate the clinical efficacy and safety of ultrasound-guided rectus sheath block (RSB) in laparoscopic umbilical hernia repair with intraperitoneal onlay mesh (IPOM).
A total of 139 patients scheduled for laparoscopic umbilical hernia repair with IPOM were selected and randomly assigned to either the group receiving general anesthesia combined with bilateral rectus sheath block (Group GR, 71 patients) or the group receiving general anesthesia alone (Group G, 68 patients). We monitored the patients' heart rate (HR) and mean arterial pressure (MAP) at four time points: before anesthesia induction (T1), at the start of surgery (T2), during mesh fixation (T3), and upon removal of the laryngeal mask (T4). Postoperative pain levels were evaluated using the Visual Analogue Scale (VAS) at 1 hour (T5), 6 hours (T6), and 12 hours (T7) after surgery while resting, as well as at 24 hours (T8) during activity. We also compared the number of times the patient-controlled intravenous analgesia (PCIA) pump was pressed and the use of additional analgesics within 24 hours post-surgery, along with recording any adverse reactions and complications associated with RSB.
At time points T2 and T3, the HR and MAP in Group GR were significantly lower than those in Group G ( < 0.05). Additionally, VAS scores at various postoperative intervals were lower in Group GR, with significant differences noted at T5, T7, and T8 ( < 0.05). Group GR also had significantly fewer presses on the analgesia pump within 24 hours post-surgery compared to Group G, while the incidence of adverse events was similar between the two groups.
Ultrasound-guided RSB is a straightforward and safe technique for laparoscopic umbilical hernia repair with IPOM. It offers clear analgesic benefits and significantly reduces early postoperative pain.
评估超声引导下腹直肌鞘阻滞（RSB）在腹腔镜经腹腔补片修补术（IPOM）治疗脐疝中的临床疗效和安全性。
选取139例行IPOM腹腔镜脐疝修补术的患者，随机分为全麻联合双侧腹直肌鞘阻滞组（GR组，71例）和单纯全麻组（G组，68例）。于麻醉诱导前（T1）、手术开始时（T2）、补片固定时（T3）及喉罩拔除时（T4）4个时间点监测患者心率（HR）和平均动脉压（MAP）。术后分别于术后1小时（T5）、6小时（T6）、12小时（T7）静息时及术后24小时（T8）活动时采用视觉模拟评分法（VAS）评估疼痛程度。比较两组患者术后24小时内自控静脉镇痛（PCIA）泵按压次数及额外使用镇痛药物的情况，并记录与RSB相关的不良反应和并发症。
在T2和T3时间点，GR组的HR和MAP显著低于G组（<0.05）。此外，GR组术后各时间段的VAS评分均较低，在T5、T7和T8时间点差异有统计学意义（<0.05）。与G组相比，GR组术后24小时内镇痛泵按压次数显著减少，两组不良事件发生率相似。
超声引导下RSB是IPOM腹腔镜脐疝修补术中一种简单、安全的技术。它具有明显的镇痛效果，可显著减轻术后早期疼痛。
