Spinal Anesthesia Versus Erector Spina Plane Block
Condition: Inguinal Hernia Repair; Postoperative Pain; Peripheral Nerve Blocks
MeSH terms: Hernia; Hernia, Inguinal
Study type: Interventional

Summary: 
      The primary aim of our study was to use spinal anesthesia for unilateral inguinal hernia
      surgery and lumbar erector spina block supported by local infiltration anesthesia in terms of
      operation time, intraoperative hemodynamic data, motor block onset time, block termination
      time, analgesic need, discharge time, patient satisfaction, surgeon satisfaction. is to
      compare. Its second purpose is to observe nausea, vomiting, urinary retention, headache,
      chills, bleeding, wound infection.
    

Detailed description: 
      Seventy cases of the American Society of Anesthesia physical status (ASA) I-III class between
      the ages of 18-75 who were hospitalized in the general surgery clinic with the diagnosis of
      unilateral inguinal hernia will be enrolled in this study prospectively and randomly. The
      entire work will be conducted in accordance with the principles of the Declaration of
      Helsinki. The patients will be determined one day in advance with the single-blind method and
      the closed envelope method, and all patients will be informed about the study plan in detail,
      and informed patient consent will be obtained.

      Patients with liver disease, allergy to anesthetic agents, local infection, recurrence,
      strangulated hernia, patients with a history of allergy to local anesthetics, and patients
      with a history of anesthesia up to two weeks ago will be excluded from the study. The general
      surgeon who performs the inguinal hernia repair surgery will not take part in the
      postoperative follow-up of the patients. Patients with a diagnosis of inguinal hernia who are
      operated on in our hospital are administered 0.1 mg.kg-midazolam 30 minutes before the block
      application. Electrocardiogram (ECG), heart rate (HR), peripheral oxygen saturation (SpO2)
      are monitored in the pre-anesthesia preparation room, and nasal hydration application with 2
      l / min O2 and 5 ml kg hr, 0.9% NaCl is started. These patients will be randomly divided into
      two groups. Patients who underwent spinal anesthesia will be named as Group 1, and patients
      who underwent Erectile Spina Block and Tumescent anesthesia as Group 2.

      Group 1 (SE) (n = 35): patients undergoing spinal anesthesia of patients in our hospital to
      do unilateral inguinal hernia operation, is taken to a seated position on the operating table
      and a 25 gauge spinal needle under sterile conditions (dominant, Turkey) subarachnoid space
      entered% in 30 seconds 0, 5 units of levobupivacaine 3 mL is injected. The intervention is
      started after the patients are placed in the supine position immediately after the spinal
      block and the level of the sensory block is confirmed by the pin prick test to be at the T10
      dermatome. Block application and the times when the sensory block reaches the T10 level are
      recorded. Surgery is allowed in patients who develop sensory block at the T10 level. During
      our study, no changes will be made to the procedure described above, which is standardized
      during our study, only patient data will be recorded observationally. Patients who do not
      have sufficient sensory block to start the procedure despite waiting 10 minutes will be
      registered and excluded from the study and additional anesthesia will be applied.

      Group 2 (Errector spina block + TA) (n = 35): To be used for each patient before the
      operation to apply tumescent anesthesia-assisted erectile spina block to patients undergoing
      unilateral inguinal hernia operation in our hospital with erectile spina block + infiltration
      anesthesia method. A total of 30 ml of mixture is prepared including lidocaine hydrochloride
      10mg / ml, adrenaline tartarate (1: 1000) 5 μg / mL, 13 ml in total, 0.5% bupivacaine
      hydrochloride 13 ml, Sterile Serum 8.4% Sodium Bicarbonate 4 ml. After hemodynamic stability,
      the patient is placed in the lateral position and infiltration anesthesia with 2% lidocaine
      is applied. Following aseptic preparation of the skin and probe, a high-frequency linear USG
      transducer is moved 2.5 cm laterally in the parasagittal plane to visualize the transverse
      projection of the first lumbar (L1) vertebra. The needle, with real-time imaging of the
      spreading injected material, TP of L1 and at this level, just below the erector spina muscle,
      5 cm, 21G peripheral nerve block needle (Pajuk®, stimuplex HNS12 Germany, Germany) is
      preferred. During the application, the needle is inserted perpendicular to the skin.
      Unilateral block is applied at T12 and L1 levels, with 10 ml in each segment. After the
      needle is withdrawn, pressure is applied to the injection area for 2 minutes and then, the
      patient is taken to the operation room, the prepared local anesthetic mixture is applied to
      the patient using the step-by-step technique, 5 ml under the skin and the subcutaneous area
      around the incision, and the other 5 ml under the fascia, the funiculus (spermatic cord).
      Tumescent anesthesia is applied around the area and the tissues at the base of the hernia
      sac. Surgery is permitted in patients who develop sensory block between T10-L1 dermatomes. In
      our study, patients whose sensory block is controlled by pin-prick test, and patients whose
      local anesthesia does not create sufficient sensory block to start the skin incision will be
      excluded from the study and additional anesthesia methods will be applied. The time during
      which the sensory blocks of the patients disappear will be recorded.

      During surgery, the sedation level of the patients will be monitored with the Ramsey sedation
      score (1: agitated, anxiosis, 2: cooperative, 3: response to verbal commands, 4: vivid
      response to glabella hit or loud stimulus, 5: lazy response to glabella beat or loud
      stimulus, 6 : no answer).
    

Intervention name(s): İnguinal Hernia Repair
Intervention type(s): Procedure
Intervention description(s): After hemodynamic stability, the patient was placed in the lateral position and infiltration anesthesia with 2% lidocaine was applied. Following aseptic preparation of the skin and probe, a medium-frequency curvey USG transducer was first placed in the midline to visualize the transverse projection of the first lumbar (L1) vertebra, then moved 2.5 cm laterally in the parasagittal plane, after imaging the transverse process, in-plane spreading was injected. Hydrodissection was achieved on the TP of L1 by using a 5 cm, 21G peripheral nerve block needle just below the erector spina muscle with real-time imaging of the substance. Afterwards, a unilateral injection of 15 ml at T12 and L1 levels was applied to each segment with the needle directed at two different angles from the same insertion point.
Other intervention name(s): Erectör spinae block; Spinal Anesthesia
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Spinal anesthesia was determined as the standard method. Erectile spina block was determined as a research group. There were equal numbers of patients in both groups. The patients to be assigned to the groups were determined by the closed envelope drawing method.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: nerve block; inguinal hernia; anesthesia; spinal