Lumme Aki, Kalliomäki Maija-Liisa, Harju Jarkko, Nordström Pia
Department of Anesthesiology, Tampere University Hospital, Tampere, Finland.
Department of Gastroenterological Surgery, Tampere University Hospital, Tampere, Finland.
World J Surg. 2025 Mar;49(3):626-633. doi: 10.1002/wjs.12481. Epub 2025 Jan 23.
Lichtenstein hernia repair is a common surgical procedure. Previously, combined rectus sheath (RS) and transversus abdominis plane (TAP) blocks have been shown to be beneficial in laparoscopic inguinal hernia surgery. Our hypothesis is that combining the two blocks will also be beneficial in open Lichtenstein hernioplasty day-case procedures.
This retrospective study analyzed data from 186 patients undergoing inguinal hernia surgery chosen using the propensity score matching. Primary endpoint was intraoperative and postoperative opioid consumption. Secondary endpoints were conversion of the anesthetic method, postoperative nausea and vomiting (PONV), unscheduled hospitalization or emergency room visits, perioperative duration, analysis of the patient flow, and surgical complications.
Ninety-three patients treated with the blocks (study group) and 93 controls were analyzed. The study group had significantly lower opioid use in the operating room (2.5-7.5 mg vs. 5.0-7.5 mg and p < 0.01) and in the recovery room (0.0-2.0 mg vs. 1.0-10.6 mg and p < 0.0001). There was no difference in postoperative recovery room times nor in the patient flow. Postoperative hospitalization due to pain was 9.1% in the control group, whereas no patients in the study group were hospitalized (p < 0.01).
RS and TAP blocks reduce postoperative pain in inguinal hernia surgery, resulting in significantly lower postoperative opioid use and hospitalization rates. The blocks are technically easy and quick to perform and should be considered for pain management in inguinal hernia day-case surgery.
李金斯坦疝修补术是一种常见的外科手术。此前，已证明联合腹直肌鞘（RS）阻滞和腹横肌平面（TAP）阻滞在腹腔镜腹股沟疝手术中有益。我们的假设是，在开放式李金斯坦疝修补日间手术中联合这两种阻滞也将有益。
这项回顾性研究分析了186例采用倾向评分匹配法选择的接受腹股沟疝手术患者的数据。主要终点是术中和术后阿片类药物的消耗量。次要终点包括麻醉方法的转换、术后恶心呕吐（PONV）、非计划住院或急诊就诊、围手术期持续时间、患者流程分析以及手术并发症。
分析了93例接受阻滞治疗的患者（研究组）和93例对照组。研究组在手术室（2.5 - 7.5毫克 vs. 5.0 - 7.5毫克，p < 0.01）和恢复室（0.0 - 2.0毫克 vs. 1.0 - 10.6毫克，p < 0.0001）的阿片类药物使用量显著更低。术后恢复室时间和患者流程方面没有差异。对照组因疼痛导致的术后住院率为9.1%，而研究组无患者住院（p < 0.01）。
RS阻滞和TAP阻滞可减轻腹股沟疝手术的术后疼痛，导致术后阿片类药物使用量和住院率显著降低。这些阻滞技术操作简便、快捷，应考虑用于腹股沟疝日间手术的疼痛管理。
