竖脊肌平面阻滞与髂腹下–髂腹股沟神经阻滞在腹股沟斜疝无张力修补术中术后镇痛效果 比较

Comparison of the Postoperative Analgesic Effects between Erector Spinae Plane Block and Iliohypogastric-Ilioinguinal Nerve Block in Tension-Free Inguinal Hernioplasty for Oblique Inguinal Hernia

摘要: 目的：比较竖脊肌平面阻滞(Erector Spinae Plane Block, ESPB)与髂腹下–髂腹股沟神经阻滞(Ilioinguinal/Iliohypogastric Nerve Block, IINB)在腹股沟斜疝无张力修补术后的镇痛效果。方法：选取2024年12月至2025年6月在内蒙古自治区人民医院行开腹腹股沟疝无张力修补术的50例患者，随机均分为ESPB组和IINB组，均于连续硬膜外麻醉下手术。ESPB组于T12横突与竖脊肌深处注射0.33%罗哌卡因20 ml，IINB组于髂腹下神经筋膜层注射相同剂量局麻药。记录术后2、6、12、24 h静息及活动时VAS评分，术前及术后睡眠质量(Richards-Campbell Sleep Questionnaire，RCSQ评分)，首次按压镇痛泵时间、24 h内按压次数，不良事件发生率及住院时间。结果：1) 两组患者基线资料均无统计学意义(P > 0.05)；2) 与IINB组相比，ESPB组术后各时点VAS评分均显著降低(P < 0.05)；术后睡眠质量更优(P < 0.05)，首次按压镇痛泵时间延迟、24 h内按压次数减少(P < 0.05)；3)两组患者不良事件发生率无显著差异(P > 0.05)。结论：研究结果表明：ESPB在腹股沟疝无张力修补术术后的镇痛效果优于IINB，可有效降低患者疼痛，缩短住院时间，改善患者预后，并提高患者满意度。

Abstract: Objective: To compare the analgesic efficacy of erector spinae plane block (ESPB) and ilioinguinal/iliohypogastric nerve block (IINB) after tension-free hernioplasty for indirect inguinal hernia. Method: Fifty patients who underwent open tension-free inguinal hernia repair at the Inner Mongolia People’s Hospital from December 2024 to June 2025 were randomly divided into ESPB and IINB groups. All surgeries were performed under continuous epidural anesthesia. The ESPB group received an injection of 20 ml of 0.33% ropivacaine at the deep fascia of the erector spinae muscle adjacent to the T12 transverse process, while the IINB group received the same dose of local anesthetic at the fascial layer surrounding the iliohypogastric nerve. Postoperative outcomes included VAS scores at rest and during activity at 2, 6, 12, and 24 hours; preoperative and postoperative sleep quality (Richards-Campbell Sleep Questionnaire, RCSQ); time to first patient-controlled analgesia (PCA) request; number of PCA demands within 24 hours; incidence of adverse events; and length of hospital stay. Results: 1) No significant differences were found in baseline characteristics between the two groups (P > 0.05). 2) Compared with the IINB group, the ESPB group exhibited significantly lower VAS scores at all postoperative time points (P < 0.05), better postoperative sleep quality (P < 0.05), delayed time to first PCA request, and fewer PCA demands within 24 hours (P < 0.05). 3) There was no significant difference in the incidence of adverse events between the groups (P > 0.05). Conclusion: ESPB provides superior postoperative analgesia compared to IINB in patients undergoing tension-free hernioplasty for indirect inguinal hernia. It effectively reduces pain, shortens hospital stay, improves patient outcomes, and enhances patient satisfaction.