腹股沟疝修补术中脊髓麻醉和椎旁神经阻滞的比较
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Comparison of spinal anesthesia and paravertebral block in inguinal hernia repair
背景与目的:腹股沟疝修补术（IHR）是一种常见的外科手术，一般可在全麻、局部或周围神经阻滞麻醉下进行。我们研究的目的是比较椎旁神经阻滞（PVB）与脊髓麻醉（SA）对IHR术后镇痛，行走和不良反应的疗效。
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方法：这是一项前瞻性单盲随机对照试验。六十名20-60岁ASAI-II级患者按电脑总名单随机分为两组，每组30名，分别为PVB组（PVB组：T12-L2，10ml 0.5％左旋布比卡因）和SA组（SA组：L3-L4 / L2-L3，2.5ml 0.5％左布比卡因）。 主要结局是术后镇痛的持续时间和达到出室标准的时间。 次要结局是达到行走的时间、阻滞有效时间、手术麻醉时间、全面消除镇痛效果的时间，不良反应、血液动力学变化、患者和外科医生满意度。使用t检验、卡方检验和社会科学统计软件包进行分析。
结果：PVB组首次镇痛持续时间为15.17±3.35h，SA组为4.67±1.03h（P <0.001）。 PVB组达到出室标准的时间明显短于SA组（P <0.001）。
结论：PVB在延长术后镇痛方面是有利的，并且与SA相比有利于早期行走。
Khetarpal R, Chatrath V, Kaur A, et al. Comparison of spinal anesthesia and paravertebral block in inguinal hernia repair[J]. 2017.
Background: CONTEXT:Inguinal hernia repair (IHR) is a common surgical procedure which can be performed under general, regional, or peripheral nerve block anesthesia.AIM:The aim of our study was to compare the efficacy of paravertebral block (PVB) with spinal anesthesia (SA) for IHR with respect to postoperative analgesia, ambulation, and adverse effects.
Methods: SETTINGS AND DESIGN:This was a prospective, single-blind randomized controlled trial..MATERIALS AND METHODS:Sixty American Society of Anesthesiologists Class I-II patients of 20-60 years scheduled for IHR were randomized by a computer-generated list into two groups of thirty each, to receive either PVB (Group PVB: at T12-L2 levels, 10 ml of 0.5% levobupivacaine at each level) or SA (Group SA: at L3-L4/L2-L3 level, 2.5 ml of 0.5% levobupivacaine). Primary outcome was duration of postoperative analgesia and time to reach discharge criteria. Secondary outcome was time to ambulation, time to perform the block, time to surgical anesthesia, total rescue analgesic consumption, adverse effects, hemodynamic changes, patient, and surgeon satisfaction. STATISTICAL ANALYSIS USED:Student's t-test, Chi-square test as applicable, and Statistical Package for Social Sciences (version 14.0, SPSS Inc., Chicago, IL, USA) were used.
Results:Time to the first analgesic requirement was 15.17 ± 3.35 h in Group PVB and 4.67 ± 1.03 h in Group SA (P < 0.001). Time to reach the discharge criteria was significantly shorter in Group PVB than Group SA (P < 0.001).
Conclusion:PVB is advantageous in terms of prolonged postoperative analgesia and encourages early ambulation compared to SA.
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