[논문]Ultrasound-guided transversalis fascia plane block versus transmuscular quadratus lumborum block for post-operative analgesia in inguinal hernia repair

Fouad, Ahmed Zaghloul; Abdel-Aal, Iman Riad M.; Gadelrab, Mohamed Rabie Mohamed Ali; Mohammed, Hany Mohammed El-Hadi Shoukat

doi:10.3344/kjp.2021.34.2.201

Ultrasound-guided transversalis fascia plane block versus transmuscular quadratus lumborum block for post-operative analgesia in inguinal hernia repair 원문보기

The Korean journal of pain, v.34 no.2, 2021년, pp.201 - 209

Fouad, Ahmed Zaghloul (Department of Anesthesia, Surgical Intensive Care and Pain Management, Cairo University) , Abdel-Aal, Iman Riad M. (Department of Anesthesia, Surgical Intensive Care and Pain Management, Cairo University) , Gadelrab, Mohamed Rabie Mohamed Ali (Department of Anesthesia, Agouza Police Hospital) , Mohammed, Hany Mohammed El-Hadi Shoukat (Department of Anesthesia, Surgical Intensive Care and Pain Management, Cairo University)

Abstract ▼ AI-Helper

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair. Methods: Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block. In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects. Results: There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically. Conclusions: The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following non-recurrent inguinal herniorrhaphy.

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표/그림 (11)

그림 Fig. 1. Flowchart of the study.
그림 Fig. 2. Sonoanatomy for QL3 block. QL: quadratus lumborum muscle, PS: psoas major muscle, ES: erector spinae muscle, TP: transverse pro-cess.
그림 Fig. 3. Picture showing spread of local anesthetic injectate in quadratus lumborum muscle (QL) block. Arrow pointing to target for local anesthetic solution deposition. LAI&N: local anesthetic injectate and needle tip, PS: psoas major muscle, VB: vertebral body.
그림 Fig. 4. Sonoanatomy for transversalis fascia plane block. EO: external oblique muscle, IO: internal oblique muscle, TA: transversus abdominis muscle, QL: quadratus lumborum muscle, PS: psoas major muscle.
그림 Fig. 5. Picture showing spread of local anesthetic solution and needle tip for transversalis fascia plane block. Arrow pointing to target for local anesthetic solution deposition. TA: transversus abdominis muscle, QL: quadratus lumborum muscle, LAI&N: local anesthetic injectate and needle tip.
그림 Fig. 6. Postoperative numerical pain rating score at rest. Data presented as mean ± standard deviation. QL: quadratus lumborum block, TF: transversalis fascia plane block.
그림 Fig. 7. Postoperative numerical pain rating score with leg movement. Data presented as mean ± standard deviation. QL: quadratus lumborum block, TF: transversalis fascia plane block.
표 Table 1. Patient data and clinical characteristics of the studied groups
그림 Fig. 8. Percentage of patients receiving postoperative rescue analgesia. QL: quadratus lumborum block, TF: transversalis fascia plane block.
그림 Fig. 9. Duration of general anesthesia (GA), surgery, and block performance time. The error bars indicate the standard deviation. QL: quadratus lumborum block, TF: transversalis fascia plane block. *Means statistically significant difference.
표 Table 2. Easiness of performance of the technique and patient satisfac-tion

참고문헌 (20)

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