Application of Single-segment Paravertebral Nerve Block in Elderly Patients Undergoing Inguinal Hernioplasty
Objective To explore the safety and feasibility of single-segment paravertebral nerve block(PVNB)in elderly patients undergoing inguinal hernioplasty.Methods A retrospective analysis was made on clinical data of 58 elderly patients who underwent open tension-free inguinal hernioplasty from January 2016 to December 2022.According to the anesthesia method,they were divided into two groups with 29 cases in each:single-segment PVNB group(P group)and single subarachnoid block group(S group).Patients in the P group were given L1 single-segment PVNB guided by ultrasound combined with peripheral nerve stimulators or simple peripheral nerve stimulators by using 0.4%ropivacaine 20 ml.Patients in the S group underwent puncture in the interspinous space between L3/4 and received 0.5%bupivacaine 10 mg.The mean arterial pressure and heart rate before anesthesia(T0),at the time of skin incision(T1),at the time of hernia sac dissection(T2),and at the time of wound closure(T3)were recorded,and the block levels,anesthetic effect,remedial rate of fentanyl,local anesthetic toxicity,peripheral nerve injury,urinary retention,delirium,and nausea and vomiting of the patients were recorded.The patient's satisfaction with anesthesia was followed up.Results All the 58 patients underwent surgery smoothly.The difference in block levels was statistically significant between the two groups of patients(Z =-4.144,P =0.000),while the differences in the remedial rate of fentanyl,anesthesia effect,and anesthesia satisfaction were not statistically significant(χ2 =0.269,P =0.604;Z =-1.430,P =0.153;Z =-1.395,P =0.163).There were no statistically significant differences in mean arterial pressure and heart rate changes between the two groups at different time points(F =0.002,P = 0.960;F =0.260,P =0.612).The rate of urinary retention in the P group was significantly lower than that in the S group(0.0%vs.24.1%,Fisher's test,P =0.010).There were no statistically significant differences in rates of dilirium and nausea and vomitting(P>0.05).All the patients did not experience local anesthetic toxicity or peripheral nerve injury during the perioperative period.Conclusion Single-segment PVNB can provide comprehensive anesthesia and analgesia for elderly patients undergoing inguinal hernioplasty,helping to maintain the stability of intraoperative hemodynamics and reducing the risk of postoperative adverse reactions.
万方数据
维普
