Application Of Ultrasound-guided Transverse Abdominal Plane Block Combined With Iliac Ilioinguinal Nerve Block In The Operation Of Inguinal Hernia In Elderly Patients

Object:To observe the effect of ultrasound-guided transverse abdominal muscle block combined with iliac subabdominal ilioinguinal nerve block in the operation of open hernia repair and the duration of postoperative pain in elderly patients,so as to seek the best method for hernia repair in elderly patientsMethod:From January 2018 to June 2019,elderly patients with open inguinal hernia repair and high ligation were selected.Patients were divided into experimental group(T:n=30)and control group(C:n=30)by random number table method,In the T group,ultrasound-guided transverse abdominal muscle block combined with iliac subabdominal ilioinguinal nerve block was used,and the ultrasound-guided transverse abdominal muscle block was given with ropivacaine at 0.4ml/kg concentration of 0.25%.Under ultrasound-guided ilioabdominoinguinal nerve block,ropivacaine with 0.25%concentration of 0.25ml/kg was given.In the C group,13-14 or 12-13 vertebral Spaces were selected for epidural puncture.After successful catheterization,the experimental dose of lidocaine was given.After excluding complications of spinal anesthesia,0.5%ropivacaine was injected into the epidural catheter with 15ml.To observe the effect of anesthesia in both groups,anesthesia operation time,adverse reaction to anesthesia,nausea and vomiting,local anesthetics poisoning,the incidence of urinary retention),record each time point(before anesthesia(T0),15 min after the anesthesia(T1),cut the skin(T2),the hernial sac mend(T3),the end of surgery(T4),6 h(T5)after operation,postoperative 12 h(T6),24 h after surgery(T7 has)elderly patients with mean arterial pressure(MAP),heart rate(HR),the change of VAS scoreResult:Comparison of general conditions of elderly patients in the two groups,such as age,ASA,BMI and operation time,showed no statistically significant difference(P>0.05).Comparison of MAP and HR at different time points between the two groups,and comparison of MAP at T1 and T2 between group T and group C showed statistically significant differences(P<0.05),while comparison of MAP at other time points showed no statistically significant differences(P>0.05).There was significant difference in HR between T group and C group at T1 and T2 time points(P<0.05),but there was no significant difference in HR at other time points(P>0.05。The VAS scores of the two groups at each time point were compared.The VAS scores of T group and C group at T3,T6 and T7 time points had statistical significance(P<0.05).The VAS scores of the other time points had no statistical significance(P>0.05).The incidence of nausea,vomiting and urinary retention in group T was better than that in group C(P<0.05);there was no significant difference in the anesthetic effect between the two groups(P>0.05);the anesthesia operation time,anesthesia cost and hospitalization days of the two groups were compared,and the incidence of nausea,vomiting and urinary retention in group T was better than that in group C(P<0.05).In group T,anesthesia operation time was shorter and anesthesia cost was lower(P<0.05);there was no significant difference in hospitalization time between the two groups(P>0.05).Conclusion:The anesthesia effect of ultrasound-guided transverse abdominal muscle plane block combined with ilioabdominal nerve block in elderly patients with inguinal hernia operation is similar to that of epidural anesthesia,the operation is relatively simple,the impact on the important life system of elderly patients is small,postoperative complications are few,providing better postoperative analgesia,and improving the perioperative safety of elderly patients and it is the better anesthetic method for inguinal hernia repair in elderly patients.