ABSTRACT
Objective:To investigate the effect of ultrasound-guided transversus abdominis plane (TAP) block combined with iliohypogastric/ilioinguinal TAP block in high-risk elderly patients undergoing inguinal hernia repair.Methods:Sixty male patients undergoing elective inguinal hernia repair, aged ≥70 years, BMI 18-23 kg/m 2, ASAⅢ-Ⅳ grade, were randomly divided into two groups: ultrasound-guided lateral TAP block combined with iliohypogastric/ilioinguinal TAP block group (combined group) and lateral TAP block group (lateral group), with 30 cases in each group. In the combined group, the injection concentration of 0.375% ropivacaine 20 ml was at the iliohypogastric/ilioinguinal TAP puncture site and the lateral TAP puncture site was also 20 ml, and the lateral group only injected 0.375% 20 ml at the lateral TAP puncture site. The Visual Analogue Scale (VAS) of the two groups were compared at surgical skin incision (T 1), opening of external oblique aponeurosis (T 2), free hernia sac (T 3), separation of preperitoneal space and patch placement (T 4), suture of transverse abdominal fascia (T 5), suture of external oblique abdominal aponeurosis (T 6) and skin incision are closed (T 7); The VAS were compared during rest and activity at 2, 4, 6, 8, 12 and 24 hours after surgery. The cumulative consumption of relief analgesics was compared. Results:Compared with the lateral group, the VAS of the combined group during T 3-T 5 was significantly lower ( P<0.05). The VAS score at 4, 6 and 8 hours after operation in the combined group was also significantly lower ( P<0.05). There was no statistical significance in VAS score at rest between the two groups 24 h after operation ( P>0.05). The cumulative consumption of relief analgesics in the combined group was lower ( P<0.05). The difference of adverse events between the two groups was not statistically significant ( P>0.05). Conclusion:In high-risk elderly patients, ultrasound-guided transverse abdominal muscle plane two-point block can be used as a safe alternative method of intraoperative analgesia.