Tek taraflı inguinal hernilerde ilioinguinal iliohipogastrik sinir bloğu ile spinal anestezi yöntemlerinin karşılaştırılması

Amaç: Tek tarafı inguinal herni cerrahisi uygulanan hastalarda ilioinguinal iliohipogastrik sinir bloğu (IHNB) ile spinal anestezi (SA) tekniklerinin hemodinamik etkileri, ameliyat sonrası analjezi, taburculuk kriterlerine ulaşma süreleri ile hasta ve cerrah memnuniyetini değerlendirmek amaçlandı. Gereç ve Yöntem: ASA I-III risk grubu 25 hastaya 3 ml %0.5 hiperbarik bupivakain ile SA (Grup S); 25 hastaya ise 20 ml %0.5 bupivakain ile IHNB (Grup I) uygulandı. Bulgular: Grup Ide Grup Sye göre ortalama blok uygulama süresi (16.4±3 ve 6.5±2.1 dk), yeterli duyusal blok oluşma süresi (25.2±5.1 vs 6.9±3.4 dk) ve duyusal bloğun sonlanması (262.4±65.2 ve 116.6 ±102.5 dk) anlamlı uzun bulundu (p

Comparison of ilioinguinal-iliohypogastric nerve block versus spinal anesthesia techniques for single sided inguinal herniorrhaphy

Objectives: Te aim of the study is to compare the hemodynamic efects, postoperative analgesia, time to achieve discharge criteria, and patient-surgeon satisfaction of patients who are assigned for single sided inguinal hernia repair operated under iliohypogastric ilioingıinal nerve block (IHNB) or spinal anesthesia. Methods: Twenty-fve ASA I-III patients in Group S received 15 mg 0.5% hyperbaric bupivacaine intrathecally, and 25 ASA I-III patients in Group I received IHNB with 20 mL 0.5% plain bupivacaine. Results: Mean block application duration (16.4±3 vs 6.5±2.1 min), mean sensory block rise time (25.2±5.1 vs 6.9±3.4 min), and time to sensory block termination (262.4±65.2 vs 116.6±102.5 min) was found to longer in Group I with respect to Group S (p<0.001). Mean time to frst mobilization (307.1±146.9 vs 456.9±131.7 min), and mean time to meet discharge criteria (4.6±0.8 vs 8.1±2.7 hr) was shorter in group I. Mean VAS scores in postoperative 1, 2, 4 and 6 th and mean tramadole consump- tion in 24 hr (375.6±113.1 vs 180.5±17.9 mg) were higher in Group S (p<0.001). Hemodynamic parameters, patient and surgeon satisfaction were comparable (p>0.05). Conclusion: IHNB provides longer postoperative analgesia and earliar discharge, although takes more time to perform and to pro- duce maximum efect, for single sided inguinal henia repair.

PDF

___

1. Hair A, Dufy K, McLean J, Taylor S, Smith H, Walker A, et al. Groin hernia repair in Scotland. Br J Surg 2000;87(12):1722-6.
2. Callesen T, Bech K, Kehlet H. One-thousand consecutive in - guinal hernia repairs under unmonitored local anesthesia. Anesth Analg 2001;93(6):1373-6.
3. Toivonen J, Permi J, Rosenberg PH. Analgesia and discharge following preincisional ilioinguinal and iliohypogastric nerve block combined with general or spinal anaesthesia for ingui- nal herniorrhaphy. Acta Anaesthesiol Scand 2004;48(4):480- 5.
4. Bugedo GJ, Cárcamo CR, Mertens RA, Dagnino JA, Muñoz HR. Preoperative percutaneous ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine for post-herniorrhaphy pain management in adults. Reg Anesth 1990;15(3):130-3.
5. Toivonen J, Permi J, Rosenberg PH. Efect of preincisional il - ioinguinal and iliohypogastric nerve block on postoperative analgesic requirement in day-surgery patients undergoing herniorrhaphy under spinal anaesthesia. Acta Anaesthesiol Scand 2001;45(5):603-7.
6. Shimoda T, Sasaoka N, Yamaguchi A, Yoshitani K, Suzuki A, Furuya H. Ilioinguinal/iliohypogastric nerve block for pedi- atric inguinal herniorrhaphy; evaluation of the dose of ropi- vacaine. [Article in Japanese] Masui 2004;53(11):1259-62. [Abstract]
7. Tsuchiya N, Ichizawa M, Yoshikawa Y, Shinomura T. Com - parison of ropivacaine with bupivacaine and lidocaine for ilioinguinal block after ambulatory inguinal hernia repair in children. Paediatr Anaesth 2004;14(6):468-70.
8. Yilmazlar A, Bilgel H, Donmez C, Guney A, Yilmazlar T, Tokat O. Comparison of ilioinguinal-iliohypogastric nerve block versus spinal anesthesia for inguinal herniorrhaphy. South Med J 2006;99(1):48-51.
9. Klein SM, Pietrobon R, Nielsen KC, Steele SM, Warner DS, Moylan JA, et al. Paravertebral somatic nerve block com- pared with peripheral nerve blocks for outpatient inguinal herniorrhaphy. Reg Anesth Pain Med 2002;27(5):476-80.
10. Ozk an D, Akkaya T, Cömert A, Balkc N, Ozdemir E, Gümüs H, et al. Paravertebral block in inguinal hernia surgeries: two seg- ments or 4 segments? Reg Anesth Pain Med 2009;34(4):312- 5.
11. Jöhr M, S ossai R. Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg 1999;88(5):1051-2.
12. Sak alli M, Ceyhan A, Uysal HY, Yazici I, Başar H. The efcacy of ilioinguinal and iliohypogastric nerve block for postopera- tive pain after caesarean section. J Res Med Sci 2010;15(1):6- 13.
13. San tos Gde C, Braga GM, Queiroz FL, Navarro TP, Gomez RS. Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for ingui- nal hernia repair under spinal anesthesia: a prospective study. [Article in English, Portuguese] Rev Assoc Med Bras 2011;57(5):545-9. [Abstract]
14. Gentili M, Huu PC, Enel D, Hollande J, Bonnet F. Sedation de - pends on the level of sensory block induced by spinal anaes- thesia. Br J Anaesth 1998;81(6):970-1.
15. Ben-David B, Vaida S, Gaitini L. The infuence of high spinal anesthesia on sensitivity to midazolam sedation. Anesth Analg 1995;81(3):525-8.
16. Yaddanapudi S, Batra YK, Balagopal A, Nagdeve NG. Se - dation in patients above 60 years of age undergoing urological surgery under spinal anesthesia: comparison of propofol and midazolam infusions. J Postgrad Med 2007;53(3):171-5.
17. N ishiyama T. Dose-fnding study of intravenous midazolam for sedation and amnesia during spinal anesthesia in pa- tients premedicated with intramuscular midazolam. J Anes- th 2004;18(4):257-61.
18. Tüzüner F, Alkış N, Aşık İ, Yılmaz AA, Tuzuner F, (editörler). Anestezi, yogun bakim, ağrı. Ankara: Güneş Kitabevi; 2010. s. 182.