Day case inguinal hernia repair under local anaesthesia with sedation

Background: Inguinal hernioplasty remain one of the most commonly performed operations worldwide. Local anaesthesia can be a preferred method in day-case hernia surgeries. Present study was thus conducted to determine whether local anaesthetic technique is an acceptable alternative to spinal anaesthesia for hernia repair, especially with regards to operative conditions, postoperative pain relief and complications.Methods: This was a prospective randomized single blinded clinical study consisting of sixty patients conducted after the ethical committee clearance. The patients posted for tension free lichtenstein elective hernioplasty were allocated to either of two groups, group A (n=30) were given local anaesthesia and patients in group B (n=30) were given spinal anaesthesia. The operative and postoperative pain sore using visual analogue scale, duration of surgery and any other complications were recorded.Results: There was no demographic difference between the two groups. Time taken in local anesthesia was higher than spinal anesthesia. Intraoperative pain was higher in local anesthesia than spinal anesthesia. There was no difference in post-operative pain scores (p>0.05). Post-operative complications were more in spinal anesthesia group e.g. urinary retention, headache, etc.Conclusions: Local anesthesia can be another good choice for inguinal hernia repair owing to its advantages and less complications, but it can’t be confirmed that local anaesthesia is better than spinal anaesthesia. It can be reliably concluded that local anaesthesia can be a preferred method in day-case hernia surgeries owing to its advantages of ease of administration and less complications.

Download Full-text

Inguinal Hernia Repair: Local or General Anaesthesia?

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x202056 ◽

2007 ◽

Vol 89 (5) ◽

pp. 497-503 ◽

Cited By ~ 43

Author(s):

P Sanjay ◽

A Woodward

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

General Anaesthesia ◽

Inguinal Hernia Repair ◽

Questionnaire Survey ◽

Local Anaesthesia ◽

Postal Questionnaire ◽

Public Hospitals ◽

Day Case ◽

Satisfaction Rates

INTRODUCTION Specialist hernia centres and public hospitals with a dedicated hernia service (Plymouth Hernia Service) have achieved remarkable results for inguinal hernia repair with the use of local anaesthesia and set the standards for groin hernia surgery. There is minimal data in the literature as to whether such results are reproducible in the National Health Service in the UK. PATIENTS AND METHODS A retrospective analysis of all inguinal hernia repairs performed in one district general hospital over a 9-year period was performed. The outcome measures were type of anaesthesia used, early and late postoperative complications and recurrence. A postal questionnaire survey was conducted to obtain satisfaction rates. In addition, a postal questionnaire survey of consultant surgeons in Wales was performed to determine the use of local anaesthesia and day-case rates for inguinal hernia repair. RESULTS A total of 577 hernia repairs were performed during the study period. Of these, 369 (64%) repairs were performed under local anaesthesia (LA) and 208 (36%) under general anaesthesia (GA). Day-case repair was achieved in 70% (400) of cases. The day-case rates were significantly higher under LA compared to GA (82.6% versus 42.6%; P < 0.05). Patients operated under LA had lower postoperative analgesic requirements and lower incidence of urinary retention compared with the GA group (P < 0.05). There were 7 (1.2%) recurrences at a median follow-up of 5.1 years (range, 10.3–2.5 years). Postal questionnaire revealed higher satisfaction rates with LA compared to GA repair. Only 15% of surgeons in Wales offer the majority of their patients local anaesthetic repair. CONCLUSIONS The use of LA results in increased day-case rates, lesser postoperative analgesic requirements and fewer micturition problems. The excellent results obtained by specialist hernia centres can be reproduced by district general hospitals by increasing the use of LA to repair inguinal hernias.

Download Full-text