Clinical Study Of Ultrasound-guided IINB Combined With RSB In Pediatric Transumbilical Single-port Laparoscopic Inguinal Surgery

Objective:This study intends to explore the clinical study of ultrasound-guided ilioinguinal iliohypogastric nerve block combined with rectus sheath block in children’s transumbilical single-port laparoscopic inguinal surgery,and analyze its anesthetic effect,safety and postoperative analgesic effect,in order to provide new ideas and references for clinical anesthesia of children’s inguinal surgery.Methods:From September 2021 to February 2022,130 children undergoing elective inguinal surgery in the hospital were selected as the research objects.They were randomly divided into GA group（general anesthesia group）,GI group（general anesthesia+ultrasound-guided ilioinguinal iliohypogastric nerve block）and GIR group（general anesthesia+ultrasound-guided ilioinguinal iliohypogastric nerve block+rectus sheath block group）.Finally,120 children were included in the study.GA group was given general anesthesia,GI group was given general anesthesia+ultrasound-guided ilioinguinal iliohypogastric nerve block,GIR group was given general anesthesia+ultrasound-guided ilioinguinal iliohypogastric nerve block combined with rectus sheath block.The operation time,postoperative recovery time,PACU residence time,analgesic pump pressing times and remifentanil dosage of children in each group were compared,At the same time,the hemodynamic indexes at different times before and after anesthesia and the scores of pain behavior assessment scale（FLACC）were compared,the perioperative adverse reactions of children in each group were recorded,and the satisfaction of family members of children in each group was compared.Result:1.Perioperative operative and anesthesia indicators:There was no significant difference in operation time among the three groups（P>0.05）,but the time of tracheal intubation removal,recovery time,PACU retention time and analgesic pump pressing times in GI group and GIR group were significantly lower than those in GA group（P<0.05）.The time of tracheal intubation removal,recovery time,PACU residence time and analgesic pump pressing times in GIR group were significantly lower than those in GI group（P<0.05）,and the dosage of remifentanil in GI group and GIR group were significantly lower than those in GA group（P<0.05）.The dosage of remifentanil in GIR group was significantly lower than that in GI group（P<0.05）.2.Hemodynamic indicators:The results of intra-group comparison showed that HR and MAP at T₂and T₃in GA group and GI group were significantly higher than those at T₀group（P<0.05）,but there was no significant difference in HR and MAP at different time in GIR group（P>0.05）.There were no significant differences in HR and MAP between the three groups at T₀,T₁and T₄（P>0.05）,but the HR and MAP of GI group and GIR group were significantly lower than those of GA group at T₂and T₃（P<0.05）,and GIR group was lower than GI group（P<0.05）.There was no significant difference in the expression level of Sp O₂in GA group,GI group and GIR group at different time（P>0.05）,and there was no significant difference in the expression level of Sp O₂among the three groups（P>0.05）.3.FLACC score:Intra-group comparison results showed that,with the extension of time,FLACC scores in the three groups were significantly lower than those at T₅（P<0.05）,and inter-group comparison results showed that there was no significant difference in FLACC scores in the three groups at T₈（P>0.05）.However,the FLACC score of GI group and GIR group at T₅,T₆and T₇was significantly lower than that of GA group（P<0.05）,and that of GIR group was lower than that of GI group（P<0.05）.4.Adverse reactions:9 children in GA group had adverse reactions.The incidence of adverse reactions in GA group was 21.43%,which was significantly higher than 5.41%and2.44%in GI group and gir group（P<0.05）,but there was no significant difference in the incidence of adverse reactions between GI group and gir group（P>0.05）;5.Family satisfaction of children:the family satisfaction of children in GI group and GIR group were 97.30%and 100.00%respectively,which was significantly higher than80.95%in GA group（P<0.05）,but there was no significant difference between GI group and GIR group（P>0.05）.Conclusion:Ultrasound-guided ilioinguinal iliohypogastric nerve block combined with rectus sheath block has a clear effect on nerve block in pediatric transumbilical single-port laparoscopic inguinal surgery,Compared with general anesthesia,it can effectively shorten the awakening time and PACU residence time of children,reduce the dosage of anesthesia drugs,and it has little influence on the hemodynamic indexes of children,which has good safety and effectiveness for clinical reference.