Inguinal hernia repair: a comparison between local and general anaesthesia

Comparison of spinal anaesthesia versus ilioinguinal-iliohypogastric nerve block applied with tumescent anaesthesia for single-sided inguinal hernia

BACKGROUND & AIMS

Primary aim of this study is to determine whether the use of local anaesthesia performed with IINB and IHNB against spinal anaesthesia in inguinal hernia repair is accepted as an alternative medicine.

METHODS

75 cases in the class of American Society of Anesthesia physical status (ASA) I-III between the ages of 18 and 75 diagnosed with single-sided inguinal hernia and hospitalized for surgery in general surgery clinic were prospectively and randomly included in this study.

RESULTS

There was statistically significant difference between the groups (30.14 ± 8.2 and 35.51 ± 9.39) in terms of the duration of the surgery. The duration was shorter in Group 1 (p < 0.001). There was statistically significant difference between the groups in terms of the duration of the first mobilization. It was significantly shorter in Group 2 than in Group 1 (5.71 ± 1.7 and 2.70 ± 1.53 min) (p < 0.001). Mean duration of length of hospital stay criteria was significantly shorter in Group 2 than in Group 1 (26.00 ± 6.43 and 14.23 ± 5.40 h) (p < 0.001). Throughout the follow-up period in postoperative 24 h, the number of patients who needed analgesia was significantly higher in Group 1 than in Group 2 (91.4% and 45.7%) There was statistically significant difference between the groups in terms of patient satisfaction and urinary retention development (p < 0.005). Hematoma development or postoperative bleeding was not observed in either group. The time of sensory block onset was significantly higher in Group 2 than in Group 1 (9.66 ± 1.41 and 9.03 ± 0.98 min) (p < 0.005) CONCLUSION: The results of our study show that IINB and IHNB applied with local anaesthesia are superior to spinal anaesthesia in unilateral inguinal hernia repairs.

Complications, Pain Control, and Patient Recovery After Local Versus General Anesthesia for Open Inguinal Hernia Repair in Adults—Systematic Review and Meta-analysis

The purpose of this systematic review is to provide an “up-to-date” evidence-based guideline and clarify the possible benefits as well as drawbacks of local anesthesia (LA) and general anesthesia (GA) in open inguinal hernia surgery in adults. Study method comprised randomized controlled trials. Primary outcome measures were complications, pain control, and patient recovery. Secondary outcome measures were patient satisfaction and hernia recurrence. A total of 14 randomized controlled trials contributed to the study. A total of 1677 patients were analyzed, with 953 in the LA group and 724 in the GA group. Complications were statistically less frequent in the LA group compared with the GA group [odds ratio (OR), 0.31; 95% confidence interval (95% CI), 0.15, 0.64). Supplemental intraoperative analgesia had a statistical significance in the LA group, with an OR of 28.93 (95% CI, 7.86, 106.47). Postoperative pain was statistically significantly lower in the LA group [standardized eman difference (SMD), −1.06; 95% CI, −1.64, −0.48)]. Length of stay was shorter for patients who underwent operation under LA compared with those receiving GA (OR, −1.21; 95% CI, −2.08, −0.33]). Time to full mobility was shorter in the LA group, without statistical significance (OR, 3.04; 95% CI, 0.19, 47.90), whereas measuring in SMD showed significance in comparison with GA (SMD, −1.74; 95% CI, −2.34, −1.14). Hernia recurrence was not noted. Patient satisfaction was greater in the LA group (SMD, 0.65; 95% CI, 0.15, 1.15). Compared with GA, LA showed superiority in terms of complications, postoperative pain, length of stay, time to full mobility, and patient satisfaction. Therefore, it appears to be a more appropriate anesthetic technique for open inguinal hernia repair in adults.

Should we abandon regional anesthesia in open inguinal hernia repair in adults?

Inguinal hernia repair is a common worldwide surgical procedure usually done in the outpatient setting. The purpose of this systematic review is to make an evidence-based meta-analysis to determine the possible benefits of regional (neuraxial block) anesthesia compared to general anesthesia in open inguinal hernia repair in adults. Cochrane Library, Medline, EMBASE, CINAHL, SCI-EXPANDED, SCOPUS as well as trial registries, conference proceedings and reference lists were searched. Only randomized controlled trials (RCT) that compare neuraxial block (spinal or/and epidural) anesthesia (NABA) and general anesthesia (GA) were included. Main outcome measures were postoperative complications, urinary retention and postoperative pain. Seven RCTs were included in this review. A total of 308 patients were analyzed with 154 patients in each group. Overall complications were evenly distributed in NABA and in GA group [OR 1.17, 95 % CI (0.52-2.66)]. Urinary retention was statistically less frequent in GA group compared to NABA group [OR 0.25, 95 % CI (0.08-0.74)]. Movement-associated pain score 24 h after surgery was significantly lower in NABA group [SMD 5.59, 95 % CI (3.69-7.50)]. Time of first analgesia application was shorter in GA group [SMD 8.99, 95 % CI 6.10-11.89]. Compared to GA, NABA appears to be a more adequate technique in terms of postoperative pain control. However, when GA is applied, patients seem to have less voiding problems.

Does regional anesthesia improve outcome after surgery?

The benefits and complications associated with regional anesthesia are assessed on the basis of a review of the recent literature. Benefits are separately considered as: (1) effects on hospital discharge; (2) effects on pulmonary function; (3) cardiac benefits; (4) effects on ambulation; (5) effects on metabolic stress responses; and (6) the preemptive effect. Complications reviewed are those of recent interest, and include epidural hematoma in association with anticoagulant therapy, and neural toxicity in association with high-dose local anesthetic.

Do race, gender, and source of payment impact on anesthetic technique for inguinal hernia repair?

STUDY OBJECTIVE

To evaluate the potential differences in the type of anesthesia provided to patients of different race, gender, and source of payment undergoing inguinal hernia repair (IHR).

DESIGN

Retrospective cohort study.

SETTING

Ambulatory surgical centers/National Survey of Ambulatory Surgery.

PATIENTS

5810 patients older than 14 years who underwent IHR in an ambulatory surgical center.

INTERVENTIONS

Inguinal hernia repair under different types of anesthesia.

MEASUREMENTS

The association of race, gender, and source of payment with different types of anesthesia for IHR as determined by multivariate regression analysis.

RESULTS

Significant discrepancies in the use of various anesthetics between patients of different race, gender, and source of payment were found. Patients identified as black and those of other minority groups were significantly more likely to receive general anesthesia compared with those identified as white (odds ratio [OR] 2.76, confidence interval [CI] 1.96-3.88 and OR 1.66, CI 1.14-2.42, respectively). Those identified as black were less likely to receive epidural anesthesia compared with their white counterparts (OR 0.36, CI 0.14-0.95). Women were less likely than men to undergo IHR with epidural anesthesia (OR 0.5, 95% CI 0.3-0.85).

CONCLUSION

Significant discrepancies in the use of various anesthetics for IHR between patients of different race, gender, and insurance status were found. Despite limitations inherent to secondary data analysis, the findings raise the possibility that nonmedical factors may influence anesthetic management.

Comparison of buffered and unbuffered local anaesthesia for inguinal hernia repair: a prospective study

Bicarbonate buffered local anaesthetic solutions are known to reduce the pain of infiltration. However, its efficacy in reducing the pain of infiltration in patients undergoing inguinal hernia repair has never been tested. This study aims to test the efficacy of bicarbonate buffered solution in reducing the pain of infiltration and pain for the total surgical procedure in a series of patients undergoing elective inguinal hernia repair. Forty consecutive male patients with unilateral, reducible inguinal hernias were studied prospectively. All patients underwent surgery under local anaesthesia, the first 20 with unbuffered solution and the next 20 using buffered solution. Pain scores were obtained for the infiltration in the anaesthetic room and for the total surgical procedure. In addition, satisfaction scores were obtained at the end of the procedure. The mean pain score for the initial infiltration of unbuffered anaesthetic was 3.00 (range 0-5), and for the buffered anaesthetic it was 1.45 (range 0-4), P=0.02. The mean pain score for the entire procedure for the unbuffered group was 3.05 (range 0-6), and for the buffered group it was 1.45 (range 0-5), P=0.02. The patient satisfaction rate was higher with the buffered solution compared to unbuffered solution (P<0.05). There were no complications reported with either solution. Buffered local anaesthetic solution significantly reduces the perceived pain of inguinal hernia repair, both during the infiltration and during the procedure itself. It is safe to administer and it results in a high rate of patient satisfaction.