Perineural versus intravenous dexmedetomidine as an adjuvant for ilioinguinal/iliohypogastric nerve block in open inguinal hernia repair: a randomised controlled trial.

IF 2.7 2区医学 Q1 SURGERY

Hernia Pub Date : 2026-10-14 DOI:10.1007/s10029-026-03866-6

Pinyada Pisutchareonpong, Chanyaphak Chumthong, Nattanicha Sirimanakul, Nutnicha Paenee, Pichchaporn Praserdvigai, Piyasak Vitayaburananont, Suphakarn Techapongsatorn, Amarit Tansawet, Wisit Kasetsermwiriya, Issaree Loapiamthong, Pakkapol Sukvibul, Pruchwilai Nuchpramool

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引用次数: 0

Abstract

Purpose: Dexmedetomidine is widely added to peripheral nerve blocks, but whether the perineural or intravenous route provides better analgesia-and at what haemodynamic cost-is unclear in inguinal hernia repair. We compared the two routes as adjuncts to an ilioinguinal/iliohypogastric (II/IH) nerve block.

Methods: This single-centre, triple-blind randomised controlled trial enrolled 90 adults (ASA I-III) undergoing elective open inguinal hernia repair. All received an ultrasound-guided II/IH block (0.5% bupivacaine with epinephrine, 20 mL) and standardised tumescent local anaesthesia, and were randomised 1:1:1 to perineural dexmedetomidine 1 µg/kg (DexLA), intravenous dexmedetomidine 1 µg/kg over 10 min (DexIV), or placebo (Control). The primary outcome was movement-evoked visual analogue scale (VAS, 0-100) pain at 6 h, analysed by intention-to-treat.

Results: Movement VAS at 6 h was lower with perineural dexmedetomidine (DexLA 10.3 ± 10.3) than DexIV (20.0 ± 17.4) or Control (22.0 ± 20.6; overall p = 0.018): DexLA versus Control - 11.7 (95% CI - 21.9 to - 1.4; p = 0.022), whereas DexIV did not differ from Control (p = 0.888). This reduction reached the established minimum clinically important difference of approximately 10 points, although pain was low overall. Time to first opioid was similar (p = 0.723). Bradycardia was more frequent with DexIV (20.0%) than DexLA (3.3%) or Control (6.7%; DexIV vs DexLA p = 0.040); hypotension occurred in 43.3%, 40.0% and 20.0% (p = 0.151).

Conclusion: Perineural-but not intravenous-dexmedetomidine produced a clinically relevant reduction in early movement-evoked pain, whereas intravenous dexmedetomidine added bradycardia without analgesic benefit. If dexmedetomidine is used in this setting, the perineural route is preferable.

Trial registration: Thai Clinical Trials Registry TCTR20220208002; registered 7 February 2022.

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在开放式腹股沟疝修补术中，右美托咪定作为髂腹股沟/髂腹下神经阻滞的辅助治疗：一项随机对照试验。

目的：右美托咪定被广泛应用于周围神经阻滞，但在腹股沟疝修补中，神经周阻滞或静脉阻滞是否能提供更好的镇痛，以及血流动力学代价是多少，目前尚不清楚。我们比较了这两条路径作为髂腹股沟/髂腹下（II/IH）神经阻滞的辅助。方法：这项单中心、三盲、随机对照试验招募了90名接受择期开放式腹股沟疝修补术的成年人（ASA I-III）。所有患者均接受超声引导下II/IH阻滞（0.5%布比卡因加肾上腺素，20ml）和标准化肿胀局部麻醉，并按1:1:1随机分配至神经周右美托咪定1µg/kg （DexLA）、静脉注射右美托咪定1µg/kg超过10分钟（DexIV）或安慰剂（对照组）。主要终点是6小时运动诱发视觉模拟评分（VAS, 0-100）疼痛，通过意向治疗进行分析。结果：神经周右美托咪定组6小时运动VAS （DexLA 10.3±10.3）低于DexIV组（20.0±17.4）或对照组（22.0±20.6；总p = 0.018）； DexLA组低于对照组（11.7）（95% CI - 21.9至- 1.4;p = 0.022），而DexIV组与对照组无差异（p = 0.888）。虽然疼痛总体上很低，但这种减少达到了大约10分的最小临床重要差异。首次使用阿片类药物的时间相似（p = 0.723）。DexIV组心动过缓发生率（20.0%）高于DexLA组（3.3%）或对照组（6.7%），DexIV vs DexLA p = 0.040；低血压发生率分别为43.3%、40.0%和20.0% （p = 0.151）。结论：神经周-而非静脉注射-右美托咪定可减少早期运动引起的疼痛，而静脉注射右美托咪定可增加心动过缓而无镇痛作用。如果右美托咪定在这种情况下使用，神经周围途径是优选的。试验注册：泰国临床试验注册中心TCTR20220208002；注册于2022年2月7日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.