Clinical Study on the Application of Ultrasound-guided Quadratus Lumborum Block Combined with Ilioinguinal/Iliohypogastric Nerve Block in Inguinal Surgery in the Elderly

Abstract

Abstract Background: This study aimed to investigate the effects of combining an ilioinguinal/iliohypogastric nerve block with an ultrasound-guided quadratus lumborum block during inguinal surgery in older patients. Methods: Between December 2020 and June 2023, 300 elderly patients who underwent inguinal surgery at our institution were randomly divided into an observation group (n = 150) and a control group (n = 150). The observation group received ultrasound-guided quadratus lumborum block in addition to ilioinguinal/iliohypogastric nerve block, whereas the control group received only ultrasound-guided ilioinguinal/iliohypogastric nerve block. The postoperative conditions and anesthesia dose (propofol and remifentanil) during surgery were recorded. The average arterial pressure and heart rate of the two groups were compared 10 min before anesthesia, 10 min after anesthesia, and postoperatively. Pain intensity was measured during and 30 min after the procedure using the pain Visual Analog Scale (VAS). The levels of malondialdehyde (MDA), aldosterone (ALD), and total antioxidant capacity (TAC) were evaluated before surgery and 1 day later, and the incidence of postoperative complications was noted and compared between the two groups. Results: The propofol and remifentanil dosages in the observation group were much lower than those in the control group, and hospital stay and recovery times were significantly shorter (P < 0.05). Ten minutes before anesthesia, there was no significant difference in the mean arterial pressure and heart rate between the two groups, and no difference at any other time point in the observation group (P > 0.05). Ten minutes after anesthesia and postoperatively, the average arterial pressure and heart rate of the observation group were lower than those of the control group, whereas those of the control group were higher than those observed preanesthesia (P < 0.05). The postoperative MDA and ALD levels in the observation group were significantly higher than those in the control group (P < 0.05), and the postoperative TAC level in the observation group was significantly lower than that in the control group (P < 0.05). The VAS scores in the observation group were significantly lower than those in the control group. No discernible difference in the frequency of complications was observed between the two groups (P > 0.05). Conclusion: The combination of ilioinguinal/iliohypogastric nerve block with ultrasound-guided quadratus lumborum block can significantly minimize the amount of anesthesia used during surgery, exert a good analgesic effect, shorten hospitalization time, stabilize hemodynamics, and reduce stress response with high safety.