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Comparison of spinal anesthesia and paravertebral block in inguinal hernia repair
背景與目的:腹股溝疝修補術(shù)(IHR)是一種常見的外科手術(shù),一般可在全麻、局部或周圍神經(jīng)阻滯麻醉下進行。我們研究的目的是比較椎旁神經(jīng)阻滯(PVB)與脊髓麻醉(SA)對IHR術(shù)后鎮(zhèn)痛,行走和不良反應(yīng)的療效。
方法:這是一項前瞻性單盲隨機對照試驗。六十名20-60歲ASAI-II級患者按電腦總名單隨機分為兩組,每組30名,分別為PVB組(PVB組:T12-L2,10ml 0.5%左旋布比卡因)和SA組(SA組:L3-L4 / L2-L3,2.5ml 0.5%左布比卡因)。 主要結(jié)局是術(shù)后鎮(zhèn)痛的持續(xù)時間和達到出室標準的時間。 次要結(jié)局是達到行走的時間、阻滯有效時間、手術(shù)麻醉時間、全面消除鎮(zhèn)痛效果的時間,不良反應(yīng)、血液動力學變化、患者和外科醫(yī)生滿意度。使用t檢驗、卡方檢驗和社會科學統(tǒng)計軟件包進行分析。
結(jié)果:PVB組首次鎮(zhèn)痛持續(xù)時間為15.17±3.35h,SA組為4.67±1.03h(P <0.001)。 PVB組達到出室標準的時間明顯短于SA組(P <0.001)。
結(jié)論:PVB在延長術(shù)后鎮(zhèn)痛方面是有利的,并且與SA相比有利于早期行走。
Khetarpal R, Chatrath V, Kaur A, et al. Comparison of spinal anesthesia and paravertebral block in inguinal hernia repair[J]. 2017.
Background: CONTEXT:Inguinal hernia repair (IHR) is a common surgical procedure which can be performed under general, regional, or peripheral nerve block anesthesia.AIM:The aim of our study was to compare the efficacy of paravertebral block (PVB) with spinal anesthesia (SA) for IHR with respect to postoperative analgesia, ambulation, and adverse effects.
Methods: SETTINGS AND DESIGN:This was a prospective, single-blind randomized controlled trial..MATERIALS AND METHODS:Sixty American Society of Anesthesiologists Class I-II patients of 20-60 years scheduled for IHR were randomized by a computer-generated list into two groups of thirty each, to receive either PVB (Group PVB: at T12-L2 levels, 10 ml of 0.5% levobupivacaine at each level) or SA (Group SA: at L3-L4/L2-L3 level, 2.5 ml of 0.5% levobupivacaine). Primary outcome was duration of postoperative analgesia and time to reach discharge criteria. Secondary outcome was time to ambulation, time to perform the block, time to surgical anesthesia, total rescue analgesic consumption, adverse effects, hemodynamic changes, patient, and surgeon satisfaction. STATISTICAL ANALYSIS USED:Student's t-test, Chi-square test as applicable, and Statistical Package for Social Sciences (version 14.0, SPSS Inc., Chicago, IL, USA) were used.
Results:Time to the first analgesic requirement was 15.17 ± 3.35 h in Group PVB and 4.67 ± 1.03 h in Group SA (P < 0.001). Time to reach the discharge criteria was significantly shorter in Group PVB than Group SA (P < 0.001).
Conclusion:PVB is advantageous in terms of prolonged postoperative analgesia and encourages early ambulation compared to SA.
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