介绍在局部麻醉(LA)下腹股沟疝的开放式假体修复已经建立,随着术中“超前镇痛”概念的发展,患者尽可能舒适。我们在全身麻醉(GA)下接受日常腹股沟疝修补术的患者中使用了切口周围的LA溶液,并记录了术后即刻使用镇痛的情况。方法在这项观察性队列研究中,100名连续未选择的男性每天接受开放式腹股沟疝修补术。其中,75例接受GA修复,25例接受切口周围LA溶液(0.5%布比卡因和1%利多卡因与1:200,000肾上腺素的等量混合物)。诱导时规定的镇痛,维持和停止麻醉后,按照世界卫生组织(WHO)的镇痛阶梯进行评分。结果GA组的中位年龄为59岁(范围:25-89岁),GA+LA组的中位年龄为59岁,这是62年(范围:27-88年)。在100个病人中,82名接受了7名外科医生的网塞修复,而18名接受了两名外科医生的扁平(Lichtenstein)网孔修复。GA+LA组的WHO镇痛诱导和术后评分显著降低(p=0.034和p<0.001)。术后止吐药的使用也存在显着差异(仅GA和GA+LA队列分别为23%和0%,p=0.020)。GA组中有6名患者(8%)未能通过日间出院标准。结论接受当代日间GA腹股沟疝修补术并预先浸润LA溶液的患者术后阿片类镇痛和止吐药水平较低。这些病例不太可能不符合计划的日间手术的出院标准。
Introduction The open prosthetic repair of inguinal hernias under local anaesthesia (LA) is well established, with the concept of intraoperative \'pre-emptive analgesia\' evolving so that patients are as comfortable as possible. We used a peri-incisional LA solution in patients undergoing day-
case inguinal hernioplasty under general anaesthesia (GA) and recorded use of analgesia in the immediate postoperative period. Methods In this observational cohort study, 100 consecutive unselected men underwent open inguinal hernia repair as a day
case. Of these, 75 underwent repair under GA and 25 with peri-incisional LA solution (equal mixture of 0.5% bupivacaine and 1% lignocaine with 1:200,000 adrenaline). Analgesia prescribed at induction, for maintenance and after cessation of anaesthesia was scored in accordance with the World Health Organization (WHO) analgesic ladder. Results The median age in the GA group was 59 years (range: 25-89 years) and in the GA+LA group, it was 62 years (range: 27-88 years). Of the 100 patients, 82 underwent a mesh plug repair by seven surgeons whereas 18 underwent a flat (Lichtenstein) mesh repair by two surgeons. WHO analgesic induction and postoperative scores were significantly lower in the GA+LA group (p=0.034 and p<0.001 respectively). There was also a significant difference in use of postoperative antiemetics (23% vs 0% in the GA only and GA+LA cohorts respectively, p=0.020). Six patients (8%) in the GA group failed day-
case discharge criteria. Conclusions Patients undergoing contemporary day-
case GA inguinal hernioplasty with pre-emptive LA solution infiltration require lower levels of postoperative opioid analgesia and antiemetics. These cases are less likely to fail discharge criteria for planned day surgery.