Application Of Ultrasound-guided Quadratus Lumborum Block In Hernia Repair Operation

Objective:To explore the effectiveness and safety of different anesthesia methods in the first unilateral inguinal tension-free hernia repair and postoperative analgesia.Methods:After review and approval by the ethics committee of our hospital,80 patients aged 18-65 years who underwent the first unilateral inguinal tension-free hernia repair in our hospital from November 2018 to November 2019 were randomly selected.ASA(American society of Aneshesiologists,American Association of Anesthesiologists)grades I-III,BMI(body mass index,body mass index)18.5-25 kg / m2,the exclusion criteria are:(1)patients who refused this experimental study;(2)patients who are allergic to local anesthetic(3)patients with a history of chronic pain before surgery;(4)patients with severe liver and kidney dysfunction,diabetes;(5)patients with coagulopathy;(6)patients with mental illness who cannot cooperate;(7)history of waist and back surgery(8)Bilateral inguinal hernia,giant hernia,incarcerated hernia,incisional hernia,recurrent hernia.Randomly divided into two groups(n = 40): lumbarscleral combined block group(group A)and lumbar square muscle block group(group Q).There were 38 males and 2 females in the combined spinal and rigid block group(group A);37 cases of oblique hernia and 3 cases of straight hernia.In the lumbar quadriceps block group,there were 37 males and 3 females;37 cases of oblique hernia and 3 cases of straight hernia.There was no significant difference in gender and type of hernia between the two groups.Results:Compared with the Q group,the first puncture success rate in the A group was lower than that in the Q group,and the difference was statistically significant(P<0.05).The postoperative recovery time was significantly longer than that in the A group,and the difference was statistically significant(P <0.05),the onset time of block A was shorter than that of Q group(P <0.05),and there was no significant difference in VAS scores at each time point of T2,T3,and T4 after block(P> 0.05).VAS score at T1 The A group was higher than the Q group,and the difference was statistically significant(P <0.05).At time T1,the MAP in group A was lower than that in Q group,and the HRwas higher than in Q group(P <0.05).The BCS score was 6 hours,12 hours,and 24 hours after operation in Q group.They were all lower than group A(P <0.05).The number of first-time remedy analgesics and the incidence of adverse reactions to anesthesia were better in group Q than in group A(P <0.05).Postoperative urine retention,headache and other complications The incidence of disease group A was higher than that of group Q(P <0.05).After the patient entered the room,the venous access was opened,and a regular mask inhaled oxygen at 3 L / min.Non-invasive arterial blood pressure,heart rate,pulse oxygen saturation,and electrocardiogram were monitored,and dexmedetomidine was slowly pumped at 0.5ug / kg / h to reduce the patient's anxiety.In group A,0.5ml ropivacaine(containing 5% glucose)was given after the cerebrospinal fluid was returned by aspiration.1.5ml-2ml of ropivacaine(containing5% glucose)was given to the affected side of group Q,and 20% of 0.5% ropivacaine was given after confirming the needle position under ultrasound guidance.If incomplete analgesia occurs during the operation(patients with VAS score> 3 points),local anesthesia with lidocaine is given in 1%.If incomplete analgesic effect occurs after surgery,intravenous flurbiprofen 1 mg / kg is added.Record the success rate of the first puncture,the time of onset of blockade,the patient's time after entering the room(T0),the anesthesia puncture(T1),the surgical incision(T2),the free hernia sac(T3)and the suture(T4).MAP,HR,and VAS scores,1% lidocaine supplementation during surgery,BCS scores at 2h,6h,12 h,and 24 h postoperatively,time to postoperative recovery,number of postoperative analgesics,and incidence of adverse reactions.Conclusion:Ultrasound-guided Quadratus lumborum block can be effectively and safely used for inguinal tension-free hernia repair,with a high success rate of one-time puncture.The intraoperative application is more stable than the combined hemodynamics of lumbar-scleral block.Can provide safer and more comfortable postoperative analgesia.Compared with combined spinal and epidural anesthesia,the incidence of postoperative complications is lower.