Comparison of Peripheral Nerve Block and Combined Spinal-Epidural Anesthesia for Anesthetic Efficacy in Adult Inguinal Hernia Repair
Objective To evaluate and compare the anesthesia efficacy of ilioinguinal/iliohypogastric nerve block in conjunc-tion with the genital branch of the genitofemoral nerve block and combined spinal-epidural anesthesia in adult patients undergo-ing unilateral inguinal hernia surgery.Methods Ninety patients with indirect inguinal hernias,scheduled for unilateral tension-free herniorrhaphy,were randomly allocated to either an ultrasound-guided ilioinguinal/iliohypogastric nerve combined with the genital branch of the genitofemoral nerve block(Group Ⅰ,n=45)or combined spinal-epidural anesthesia(Group C,n=45).The sensory block of the skin area and motor function of the lower limbs were assessed.Heart rate and mean arterial pressure were compared between the two groups before anesthesia,5 min after anesthesia,at beginning of skin incision,during stretching of the spermatic cord/round ligament,and during high ligation of the hernia sac.The need for sufentanil,additional local anesthet-ics,and the use of blood pressure medications were also evaluated.Postoperative Visual Analogue Scale(VAS)scores at rest and the number of patient-controlled analgesia compressions were compared between the two groups.Results Both groups demon-strated effective sensory block of the skin area(both P＞0.05).However,there was a significant difference in motor block of the lower limbs between the groups.In Group Ⅰ,44 patients exhibited no motor block,whereas in Group C,a bilateral lower limb motor block of grade 2 or higher was observed(P＜0.05).Five minutes after anesthesia,some patients in Group C showed an increased heart rate along with a decreased mean arterial pressure,suggesting a potential adverse effect of the intervention(P＜0.05).Additionally,vasoactive drug(methoxamine)was used in 6 patients in Group C,which was not used in group I(P＜0.05).The VAS scores and the number of analgesic pump presses at 6 and 12 hours post-surgery were significantly lower in Group I compared to Group C(both P＜0.05).Conclusion The combined ilioinguinal/iliohypogastric nerve block with the gen-ital branch of the genitofemoral nerve block is as effective as combined spinal-epidural anesthesia for achieving sensory nerve block and anesthesia in adult patients undergoing open unilateral inguinal herniorrhaphy,with less systemic impact compared to combined spinal-epidural anesthesia.
万方数据
维普
