髂腹股沟/髂下腹、腹横肌平面和腰方肌阻滞在腹股沟疝手术中的镇痛效果：一项前瞻性随机对照试验

摘要(中文译文)

目的：本研究比较了髂腹股沟/髂腹下神经阻滞、腹横肌平面阻滞和腰方肌阻滞作为脊髓麻醉辅助手段，在单侧腹股沟疝修补术后疼痛管理中的疗效。方法：本研究为前瞻性、随机、对照、单盲研究。80例患者被随机分为四组：（a）髂腹股沟/髂腹下神经阻滞组；（b）腹横肌平面阻滞组；（c）腰方肌阻滞组；（d）对照组。采用视觉模拟评分法评估术后24小时静息和活动时的疼痛。记录经患者自控镇痛的总曲马多消耗量、补充对乙酰氨基酚的使用情况以及阿片类药物相关不良反应。结果：各组在任何时间点的视觉模拟评分均无统计学显著差异（P>0.05）。阿片类药物消耗量范围为60至300 mg，平均值为226.79±49.94 mg。各组间阿片类药物使用无统计学显著差异（P=0.930；P>0.05）。各组间额外镇痛药的需求无显著差异（P=0.389；P>0.05）。不良反应（术后恶心呕吐和呼吸抑制）的总体发生率为11.2%（n=9）。各组间不良反应发生率无统计学显著差异（P=0.069；P>0.05）。结论：三个阻滞组与对照组在疼痛评分、阿片类药物消耗或不良反应方面均未观察到统计学显著差异。与腹横肌平面阻滞组和腰方肌阻滞组相比，髂腹股沟/髂腹下神经阻滞组在术后期间视觉模拟评分有降低趋势，但无统计学意义。尽管三个阻滞组需要额外镇痛药的患者总数均低于对照组，但这些发现无统计学意义。临床试验编号：本试验已在clinicaltrials.gov进行回顾性注册，试验编号为NCT06997536。

Abstract

ObjectiveThis study compared the efficacy of ilioinguinal/iliohypogastric, transversus abdominis plane, and quadratus lumborum blocks as adjuncts to spinal anesthesia for postoperative pain management in unilateral inguinal hernia repair.MethodsThis study was a prospective, randomized, controlled, single-blind study. Eighty patients were randomized into four groups: (a) ilioinguinal/iliohypogastric block group; (b) transversus abdominis plane block group; (c) quadratus lumborum block; and (d) control group. Postoperative pain was assessed using the visual analog scale at rest and during movement over 24 h. Total tramadol consumption via patient-controlled analgesia, supplemental paracetamol use, and opioid-related adverse effects were recorded.ResultsNo statistically significant differences were found in visual analog scale scores among the groups at any time point ( > 0.05). Opioid consumption ranged from 60 to 300 mg, with a mean value of 226.79 ± 49.94 mg. There was no statistically significant difference in opioid use among the groups ( = 0.930; > 0.05). The requirement for additional analgesics did not differ significantly among the groups ( = 0.389; > 0.05). The overall incidence of adverse effects (postoperative nausea and vomiting, and respiratory depression) was 11.2% ( = 9). No statistically significant differences were observed in the rate of adverse effects between the groups ( = 0.069; > 0.05).ConclusionNo statistically significant differences were observed in pain scores, opioid consumption, or adverse effects between the three block groups and the control group. There was a nonsignificant trend toward lower visual analog scale scores in the ilioinguinal/iliohypogastric group compared with the transversus abdominis plane and quadratus lumborum groups during the postoperative period. Although the total number of patients requiring additional analgesics was lower in all three block groups compared with the control group, these findings were not statistically significant.Clinical Trial NumberThis trial was retrospectively registered at clinicaltrials.gov with trial number NCT06997536.

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