Application Of Ultrasound-guided Two-point Block Of Transverse Abdominal Muscle Plane In High-risk Elderly Patients With Inguinal Hernia Repair

Objective:To investigate the effect of ultrasound-guided transversus abdominis muscle plane（TAP）block combined with iliohypogastric/ilioinguinal TAP block in high-risk elderly patients with inguinal hernia repair.Methods:Sixty high-risk elderly male patients with elective inguinal hernia repair,aged≥70 years,BMI 18～23kg/m²,ASAⅢ-IV grade,were divided into two groups by random number table:ultrasound-guided lateral TAP block combined with iliohypogastric/ilioinguinal TAP block group（combined group）and lateral TAP block group（lateral group）,30 cases in each group.In the combined group,the concentration of 0.375%ropivacaine was injected at the puncture site of the iliohypogastric/ilioinguinal TAP and the lateral TAP,each site was 20 ml.The lateral group only injected 0.375%ropivacaine 20 ml at the puncture site of lateral TAP.VAS pain score were recorded at surgical skin incision（T₁）,opening of external oblique aponeurosis（T₂）,free hernia sac（T₃）,separation of preperitoneal space and patch placement（T₄）,suture of transverse abdominal fascia（T₅）,suture of external oblique abdominal aponeurosis（T₆）and skin incision are closed（T₇）.VAS pain score were recorded during rest and activity at 2,4,6,8,12 and 24 h after surgery.The dosage of lidocaine,sufentanil,morphine and tramadol hydrochloride tablets were recorded,and the adverse events such as nausea and vomiting,local anesthetic poisoning,puncture needle into abdominal cavity,visceral injury,cardio-cerebrovascular accident were recorded.Results:Compared with the lateral group,the VAS pain score of the combined group during T₃-T₅was significantly lower than that of the lateral group（P<0.05）.The VAS pain score at 4,6 and 8 hours after operation in the combined group was significantly lower than that in the lateral group（P<0.05）.The dosage of rescue analgesia with lidocaine and sufentanil during operation and the consumption of tramadol hydrochloride tablets 24 hours after operation in the combined group were significantly lower than those in the lateral group（P<0.05）.There was no significant difference in the incidence of nausea and vomiting between the two groups,and no other adverse events occurred in the two groups.Conclusion:When general anesthesia or spinal anesthesia anesthesia is contraindicated in high-risk elderly patients,ultrasound-guided two-point block of the transverse abdominal muscle plane can be used as a safe and effective anesthesia method.Two-point block of the transverse abdominis muscle plane can significantly reduce the remedial dosage of lidocaine and sufentanil during the operation,as well as the VAS pain score during activity within 8 hours after the operation and the cumulative consumption of remedial analgesics.In the context of postoperative multimodal analgesia,inguinal hernia repair with a smaller incision may have limited benefits from transversus abdominis muscle plane block.This is reflected in the fact that there is no significant difference in the resting VAS score between the two groups.