Tek Taraflı İnguinal Herni Tamiri ve İlioinguinal İliohipogastrik Blok: Perioperatif ve Postoperatif Bulgularımız

Amaç: Tek taraflı inguinal herni cerrahisi uygulanan hastalarda spinal anesteziye eklenen ilioinguinal iliohipogastrik sinir bloğu (IIIHNB) ile tek başına spinal anestezi (SA) tekniklerinin hemodinamik etkileri, ameliyat sonrası analjezi, taburculuk kriterlerine ulaşma süreleri ile hasta ve cerrah memnuniyetini değerlendirmeyi amaçladık. Gereç ve Yöntem: ASA I-II risk grubu 25 hastaya 3 ml %0.5 hiperbarik bupivakain ile SA (Grup S); 25 hastaya ise spinal anesteziye ek olarak 20 ml %0.5 bupivakain ile IIIHNB (Grup SII) uygulandı. Bulgular: Grup SII'de Grup S'ye göre ortalama blok uygulama süresi (20.1±4.1 ve 3.5±2.9 dk) anlamlı uzun bulundu. Yeterli duyusal blok oluşma süresi karşılaştırıldığında (21.3±6.5 ve 7.8±2.9 dk) Grup S'de anlamlı uzundu. Duyusal bloğun sonlanması ise (129.6±103.9 ve 404.5±71.2 dk) Grup SII'de anlamlı uzun bulundu (p=0.034). Gruplar arasında ilk mobilizasyon süreleri ve taburculuk kriterlerine ulaşma süresi arasında fark yoktu (sırasıyla, p=0.079, p=0.084). Grup SII'de ameliyat sonrası bir, iki, dört ve altıncı ve onikinci saat ortalama VAS değerleri anlamlı düşük idi (sırasıyla p=0.016, p=0.029, p=0.038, p=0.042, p=0.031). Postoperatif ilk 12 saatlik dönemde Grup S'de 8 hastada tramadol ihtiyacı olmuşken, Grup SII'de tramadol ihtiyacı olan hastaya rastlanmadı. Her iki gruptada başarısız blok nedeniyle çalışma dışı bırakılan olgu olmadı. Her iki grupta perioperatif vital bulgular stabil seyretti ve istatistiksel analizde anlamlı fark bulunmadı. Sonuç: Tek taraflı inguinal herni cerrahisinde spinal anesteziye ek olarak IIIHNB uygulaması, daha uzun süreli ameliyat sonrası analjezi sağlamakta hasta konforunu artırmaktadır.

Unilateral Inguinal Hernia Repair and Ilioinguinal Iliohypogastric Block: Our Perioperative and Postoperative Findings

Objective: The purpose of this study is to evaluate hemodynamic effects, postoperative analgesia, the time period to reach the discharge criteria and satisfaction of the patient and the surgeon by spinal anaesthesia (SA) alone and ilioinguinal iliohypogastric nerve block (IIIHNB) combined with spinal anaesthesia in patients undergoing unilateral inguinal hernia surgery. Material and Method: 3 ml of 0.5% hyperbaric bupivacaine SA (Group S) was given to 25 patients in ASA I-II risk group; and 20 ml of 0.5% bupivacaine and IIIHNB (Group SII) were given to 25 patients in addition to spinal anaesthesia. Results: The average block practice time for Group SII was found to be significantly long compared to Group S (20.1±4.1 and 3.5±2.9 min.). When sufficient sensory block formation time was compared (21.3±6.5 and 7.8±2.9 min.), it was found to be significantly longer in Group S. At the end of sensory block time, it was also significantly longer for Group SII (129.6±103.9 and 404.5±71.2 min) (p=0.034) .There was no difference detected in the initial mobilization period and the time period to reach discharge criteria between the groups (respectively p=0.079,p=0.084). The average VAS values for Group SII in the first, second, fourth, sixth and twelfth hours after the operation were significantly low (respectively p=0.016, p=0.029, p=0.038, p=0.042, p=0.031). In the postoperative period of the first 12 hour there was a need for tramadole in 8 patients in Group S, but not in Group SII. In both of the groups, none of the patients were excluded from the study because of failed blocks. Patient and surgeon satisfaction were similar between the groups. Perioperative vital signs remained stable in both groups and there was no significant difference in the statistical analysis Conclusion: IIIHNB application in addition to spinal anaesthesia in the surgery of unilateral inguinal hernia, provides longer lasting postoperative analgesia and increases patients' comfort.

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  • 1. Kehlet H, Nielsen Bay M. Anaesthetic practice for groin hernia repair - a nation wide study in Denmark 1998-2003. Acta Anaesthesiol Scand 2005; 49: 143-6.
  • 2. Raeder J. Best anesthetic method for inguinal hernia repair? Acta Anaesthesiol Scan 2005; 49: 131- 2.
  • 3. Collins VJ (Editor). Spinal anesthesia- principles: Principles of Anesthesiology. Philadelphia: Lea & Febiger, 1993. 1445-97.
  • 4. Kayhan Z. Santral Bloklar (Spinal ve epidural anestezi): Z Kayhan (Editör). Klinik Anestezi. 3. Baskı. İstanbul: Logos Yayıncılık, 2004; 552-89.
  • 5. Toivonen J, Permi J, Rosenberg PH. Analgesia and discharge following preincisional ilioinguinal and iliohypogastric nerve block combined with general or spinal anaesthesia for inguinal herniorrhaphy. Acta Anaesthesiol Scand 2004; 48: 480-5.
  • 6. 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: 130-3.
  • 7. Toivonen J, Permi J, Rosenberg PH. Effect of preincisional ilioinguinal and iliohypogastric nerve block on postoperative analgesic requirement in day-surgery patients undergoing herniorrhaphy under spinal anaesthesia. Acta Anaesthesiol Scand 2001; 45: 603-7.
  • 8. Shimoda T, Sasaoka N, Yamaguchi A, Yoshitani K, Suzuki A, Furuya H. Ilioingunal/iliohypogastric nerve block for pediatric inguinal herniorrhaphy; evaluation of the dose of ropivacain Masui 2004; 53: 1259-62.
  • 9. Tsuchiya N, Ichizawa M, Yoshikawa Y, Shinomura T. Comparison of ropivacaine with bupivacaine and lidocaine for ilioinguinal block after ambulatory inguinal hernia repair in children. Paediatr Anaesth 2004; 14: 468-70.
  • 10. Yilmazlar A, Bilgel H, Donmez C, Guney A, Yilmazlar T, Tokat O. Comparison of ilioinguinaliliohypogastric nerve block versus spinal anesthesia for inguinal herniorrhaphy. South Med J 2006; 99: 48-51.
  • 11. Ozkan D, Akkaya T, Cömert A, et al. Paravertebral block in inguinal hernia surgeries: two segments or 4 segments? Reg Anesth Pain Med 2009; 34: 312- 5.
  • 12. Gürkan I, Ütebey G, Özlü O. Tek taraflı inguinal hernilerde ilioinguinal iliohipogastrik sinir bloğu ile spinal anestezi yöntemlerinin karşılaştırılması. Ağrı 2013; 25: 108-14.
  • 13. Jöhr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg 1999; 88: 1051-2.
  • 14. Sakalli M, Ceyhan A, Uysal HY, Yazici I, Başar H. The efficacy of ilioinguinal and iliohypogastric nerve block for postoperative pain after caesarean section. J Res Med Sci 2010; 15: 6-13.
  • 15. Santos Gde C, Braga GM, Queiroz FL, Navarro TP, Gomez RS. Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study. Rev Assoc Med Bras 2011; 57: 545-9.
Fırat Tıp Dergisi-Cover
  • ISSN: 1300-9818
  • Başlangıç: 2015
  • Yayıncı: Fırat Üniversitesi Tıp Fakültesi