To explore the safety and efficacy of transversus abdominis plane (TAP) nerve block combined with ilioinguinal-iliohypogastric (IIIH) nerve block as the anesthesia method in the treatment of inguinal hernia in high risk elderly patients.

Sixty eight high risk elderly patients undergoing elective inguinal hernia repair from April 2017 to April 2018 in Xinjiang Uygur Autonomous Region People’s Hospital were included. Among them, 35 cases were TAP group with TAP combined with IIIH nerve block and 33 were LAI group with local anesthesia. 2mg midazolam and 5ug sufentanil were given to the two groups before the operation. The VAS scores of two groups at T1 (cutting time), T2 (opening of the external oblique aponeurosis), T3 (free sac when), T4 (separation of the separation of the preperitoneal space when the patch), T5 (suture abdominal Transverse fascia), T6 (suture abdominal oblique myofascial), T7 (skin incision closed) were observed in the operation. The VAS scores of 2h, 12h, 24h hours in rest and exertion (cough) status after the surgery were performed. The quantity of intraoperative supplemental sufentanil, the patient's satisfaction with anesthesia, anesthesia cost, operating time, postoperative recovery time, hospitalization days and anesthesia complications after 4 weeks of the operation were all recorded.

The VAS scores of 6 time points (T2-T7)in the TAP group were lower than that in LAI group (t=-4.635, -7.309, -5.994, -8.888, -4.499, -8.132; all P<0.01). The VAS scores of 2 hours and 12 hours in rest and exertion status after the operation in TAP group were significantly lower than that in LAI group (t=-7.295, 77.283, -6.606, -3.034; P<0.05 or P<0.01). There was no statistically significant difference (t=-2.293, -1.365; all P>0.05) of the VAS score assessed 24h after the operation in rest and exertion status between the two groups. Compared with patients in the LAI group, patients in the TAP-IIIH group had less sufentanil addition, higher patient satisfaction scores, shorter operative time, and shorter postoperative recovery time, but the anesthesia costs were higher. which were statistically significant (t=-6.433, 3.639, -4.238, -2.518, 21.645; P<0.05 or P<0.01). There was no statistical difference in hospital stay and postoperative anesthesia complications between the two groups (t=1.797, P>0.05).

The use of TAP combined with IIIH nerve block as the main anesthetic technique is safe and effective in inguinal hernia repair in high risk elderly patients.