| ObjectiveIn recent years, the methods of nerve block have fundamentally innovated with the development of ultrasound technology. Compared to the"two-pop"method, ultrasound-guided transversus abdominis plane block has its unique clinical advantages, expecially in the anesthesia of the abdomen small operation. The aim of this study was to research the the repair of inguinal hernia in the old man under the high-resolution sonography, to determine the scope ,the time and the anesthetic of transversus abdominis plane block, also observe the analgesic efficacy of ultrasound-guided transversus abdominis plane block with different concentrations of local anesthetics.MethodsPart one: Eleven patients scheduled for the repair of inguinal hernia, male patients, aged 65 to 80 years old, ASAⅡ~Ⅲ, with the body mass index between 17.72 to 27.76 kg·m-2. We use a portable ultrasound systems with a linear 6 to 13 MHz transducer. Marked the iliac crest, the rib margin and the midaxillary line, then placed the transducer at the anterior abdominal wall closed to the iliac crest. When the transversus abdomins plane sonogram appeared clearly, puncture point with 20G needle was located outside the transducer about 1 cm (between the iliac crest and the costal at the midaxillary line) with 1.0% lidocaine 1 ml for local anesthesia through in-plane technology. When the transversus abdomins plane was decided with the water separation technology, then 0.25% bupivacaine 20 ml was injected to the transversus abdomins plane. We determined the scope, the operation time and the anesthetic of transversus abdominis plane block.Part two: Seventy-five scheduled patients for the repair of inguinal hernia with combined spinal-epidural anesthesia were randomly divided into three groups: control group with no treatment (Group B), ultrasound-guided transversus abdomins plane with 0.25% bupivacaine 20 ml (Group L) and ultrasound-guided transversus abdomins plane with 0.375% bupivacaine 20 ml (Group H). The method of the ultrasound-guided transversus abdomins plane was the same as the part one. The operation time of the three groups and the scope of the transversus abdomins plane at the 4 h, 6 h, 8 h, 12 h, 24 h and 48 h postoperatively was recorded, evaluated the analgesic efficacy of the ultrasound-guided transversus abdomins plane at the 4 h, 6 h, 8 h, 12 h, 24 h and 48 h postoperatively of three groups.ResultsPart one: The pain effect of ultrasound-guided transversus abdomins plane with 0.25% bupivacaine 20 ml was weakened, the maximum range was thoracic 10 (T10, 9/11), and the anesthetic effect was good fine (63.64%, 7/11).Part two: No significant difference in the demographic characteristics such as age, the height, the weight, the body mass index and the operation time was observed among three groups (P>0.05). There was no significant difference in the block range between Group L and Group H at every time point postoperatively(P>0.05), the block range at the 4 h postoperatively was between T10 to T12 (86.95% and 79.16%), the block range at the 6 h postoperatively was around the incision (69.57% and 75%), the block range at the 8 h almost disappeared, except a little patients had the block range (30.43% and 58.33%), but there was no block range after 12 h postoperatively. Compared with Group B, there were significant differences between Group L and Group H in 4 h to 8 h postoperatively about the VAS(P<0.05, rest and movement), but no significant difference 12 h later (P>0.05). There were significant differences between the rest and the movement among three groups (P<0.05). Compared with Group B, there were significant differences between Group L and Group H in 6 h about the use of the fulrbiprofen (P<0.05), no difference 8 h later postoperatively. Compared with Group B, there were significant differences between Group L and Group H about the satisfaction of analgesia (86.96%, 91.67% and 50.00%, P<0.05).ConclusionsPart one: 0.25% bupivacaine 20 ml ultrasound-guided transversus abdomins plane at the midaxillary line from the aboral to the anterior may have some pain decreased plane.Part two: (1) Patients had a single injection 0.25% and 0.375% bupivacaine 20 ml of ultrasound-guided transversus abdomins plane block can effectively maintain 8 h for postoperative analgesia; (2) There is no difference between 0.25% bupivacaine and 0.375% bupivacaine about the maintenance of analgesia and the time; (3) Ultrasound-guided transversus abdomins plane has a good postoperative analgesia effect, not only in the restding, but also in the movement. And the patients received transversus abdomins plane block have better analgesic satisfaction. |
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