Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair
Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair
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DOI：
10.1093/bja/aeq363
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发表时间：
2011-03-01
影响因子：
9.8
通讯作者：
Bonnet, F.
中科院分区：
文献类型：
--
作者：
Aveline, C.;Le Hetet, H.;Bonnet, F.
背景资料。腹壁横断神经阻滞(TAP)在下腹部手术后能提供有效的镇痛效果已有报道，但在腹股沟疝修补术中，将髂腹股沟/髂腹下神经(IHN)与超声引导下的TAP进行比较的资料较少。273例日间腹股沟腹股沟疝修补术患者随机分为两组，分别在超声引导下行腹股沟疝修补术和左旋布比卡因加0.5%左旋布比卡因盲法腹股沟疝修补术。监测患者安静时(麻醉后监护室内、4、12h)、安静时、活动时(24、48h、3、6个月)的视觉模拟评分(VAS)。用DN4神经病理性疼痛问卷对6个月后的疼痛进行评估。超声引导下TAP组静息时疼痛评分低于对照组，分别为4h(11vs15，P=0.04)、12h(20vs30，P=0.0014)和24h(29vs33，P=0.013)。术后24 h、术后3个月、6个月疼痛程度两组相似(P=NS)。TAP组和IHN组在6个月时VAS和GT；40 mm活动度的比例分别为18.2%[95%CI(12.2-26.1%)]和22.4%(15.8-30.6%)，P=0.8。TAP阻滞组术后24 h内吗啡用量较低(P=0.03)。腹股沟疝修补术后，超声引导下的TAP阻滞比“盲法”IHN阻滞能更好地控制疼痛，但不能预防慢性疼痛的发生。
Background. Transversus abdominis plane (TAP) block has been reported to provide effective analgesia after lower abdominal surgery, but there are few data comparing ilioinguinal/iliohypogastric nerve (IHN) block with ultrasound-guided TAP block in patients undergoing inguinal hernia repair.Methods. Two hundred and seventy-three patients undergoing day-case open inguinal hernia repair with a mesh were randomly allocated to receive either ultrasound-guided TAP block or blind IHN block with levobupivacaine 0.5%, before surgery. Patients were monitored for visual analogue scale (VAS) scores at rest (in the post-anaesthesia care unit, and at 4 and 12 h) and at rest and during movement (at 24, 48 h, 3 and 6 months). Pain at 6 months was also assessed using the DN4 questionnaire for neuropathic pain.Results. Median VAS pain scores at rest were lower in the ultrasound-guided TAP group at 4 h (11 vs 15, P = 0.04), at 12 h (20 vs 30, P = 0.0014), and at 24 h (29 vs 33, P = 0.013). Pain after the first 24 h, at 3 and 6 months after surgery, and DN4 scores were similar in both groups (P = NS). The proportion of patients with VAS >40 mm on movement at 6 months was comparable {18.2% [ 95% CI (12.2-26.1%)] vs 22.4% (15.8-30.6%) in the TAP and IHN groups, respectively, P = 0.8}. Postoperative morphine requirements were lower during the first 24 h in the TAP block group (P = 0.03).Conclusions. Ultrasound-guided TAP block provided better pain control than 'blind' IHN block after inguinal hernia repair but did not prevent the occurrence of chronic pain.