Journal: Ann Surg 247(3):540-543, 2008. 31 References
Reprint: Ikazia Hospital Rotterdam, Dept of Surgery, PO Box 5009, Montessoriweg 1,3008 AN, Rotterdam, The Netherlands (RN van Veen, MD) TT.02 SP0812/252 ©2008
Faculty Disclosure: Abstracted by T. Tilton, who has nothing to disclose.
In a randomized, controlled trial, the authors com¬pared local infiltration anesthesia (LIA) to spinal anesthesia (SA) in 117 patients scheduled for repair of unilateral inguinal hernia (IH) as described by Lichtenstein and Amid. Exclusion criteria were <18 years of age, recurrent hernia, femoral or bilateral hernia, pregnancy, bleeding abnormalities, or any contraindication to SA. Patients were randomly assigned to receive either LIA or SA with the primary end point being pain during the first postoperative week and secondary end points of complications, length of postoperative stay, time to return to normal activities and any anesthesiologist intervention in patients with LIA. Patients were asked to maintain an activity diary after discharge through day 7; quality of life surveys were also completed.
SA consisted of heavy bupivacaine (0.5%) with sufentanil (5 μg/ml). LIA was placed by the surgeon consisting of a maximum mixture of 40 mL lidocaine (1%), epinephrine (2%) and bupivacaine (0.5%). Mesh repair was accomplished as described by Lichtenstein. Seventeen patients were ultimately excluded; 49 received SA and 51 received LIA. Demographics were similar between groups. Reports of intraoperative pain were 12 (25%) with SA compared with 18 (35%) with LIA (P=0.167). Pain was significantly more after surgery with SA versus LIA. Overnight admissions were 12 (24%) versus 2 (4%); urinary retention (>3 hr after surgery) was 37 (76%) versus 10 (20%), respectively. Median time for placement of SA (by anesthesiologist) versus LIA (by surgeon) was 21 (range 10-40) minutes versus 10 (5-30), P<0.001. Complications within 3 months postoperatively were: hematoma (12 vs. 16%); wound infection (4 vs. 6%); reintervention (0% both groups); numbness (31 vs. 29%); normal daily activities (61 vs. 92%); and preservation/division of one or more inguinal nerves (80/20 vs. 74/26%), respectively.
In conclusion, LIA is superior to SA for repair of IH providing highly satisfactory intraoperative analgesia, faster recovery, less postoperative pain, no urinary retention, faster mobilization, and higher satisfaction in the first 3 months postoperatively. Hospital benefits include shorter total operating time, lack of need for an anesthesiologist, and decreased hospital stay. LIA should be considered the method of choice for IH repair. |
