Details
Category: Volume 4 Issue 12 Dec 2016
Hits: 5220

Title: Inguinal Hernia Repair: Comparison of Local Anaesthesia and Spinal Anaesthesia

Authors: Dr Amul Bhedi, Dr Sushil Damor, Dr Arnab Sarkar

 DOI:  https://dx.doi.org/10.18535/jmscr/v4i12.40

Abstract

Background: Inguinal hernia repair remains one of the most commonly performed operations worldwide. Today, local anaesthesia is the most preferred type over spinal and general anaesthesia in day-case hernia surgeries. Advantages being postoperative pain relief, early ambulation, shorter hospital stay and lesser costs. The condition of patient, surgeon’s experience and technical factors also play a role in this. Hence, this study will help us to discuss the factors that can help us to decide the effectiveness of local anaesthesia in day-case hernia surgeries.

Aims and Objectives: To determine whether local anaesthetic technique was an acceptable alternative to spinal anaesthesia for hernia repair, especially with regards to operative condition, patients & surgeons satisfaction, postoperative pain relief & complications and economical benefits.

Settings and Design: This was a prospective clinical study consisting of 60 patients undergoing Lichtenstein’s inguinal hernia repair, out of which 30 were given local anaesthesia and 30 were given spinal anaesthesia. All patients admitted in Department of General Surgery, SSG Hospital, Vadodara attached to the Medical College Baroda from September 2007 to January 2008.

Materials and Methods: Data was collected by meticulous history taking, careful clinical examination, appropriate radiological, haematological investigation, operative findings and follow-up of the cases.

Results: Immediate post-operative pain relief was more in LA group as compared to SA group, whereas after 24 hours, there was no significant difference in the pain scores between the two groups. Only three patients in SA group had micturition complaints post-operatively. Recovery from anesthesia was significantly faster for patients in the LA group than those in the SA group which had a mean interval of 4.1 hours. There was no significant difference in operative time and duration of hospital stay in the two groups.

Conclusion: It can be reliably concluded that local anaesthesia can be a preferred method in day-case hernia surgeries owing to its advantages. However, the experience of the surgeon and proper participation by the patient should also be looked upon in such cases.

Keywords: Inguinal hernia, Local anaesthesia, Spinal anaesthesia, Pain, Hernioplasty, Day-case surgery.

References

 1.      Kehlet H and White PF. Optimizing anaesthesia for inguinal herniorrhaphy: General, Regional or local anaesthesia? Anesth Analg 2001; 93: 1367 – 9

2.      Subramaniam P, Leslie J Gourlay C, Clezy JK. Inguinal hernia repair: A comparison between local and general anaesthesia. Aust NZJ Surg 1998; 68: 799 – 800

3.      Callesen T, Bech K, Kehlet H. The feasibility, safety and cost of infiltration anaesthesia for hernia repair. Anaesthesia 1998; 53: 31-5

4.      O’ Dwyer PJ, Serpell MG, Millar K, et al. Local or general anaesthesia for open hernia repair. A randomized trial. Annals of Surgery 2003; 237: 574-9

5.      Ozgun H, Kurt MN, Kurt l, Cevikel MH. Comparison of local, spinal and general anaesthesia for inguinal herniorrhaphy, Eur J Surg 2002; 168: 455 - 9

6.      Callesen T, Bech K, Kehlet H. One thousand consecutive inguinal hernia repairs under unmonitored local anaesthesia. Anesth Analg 2001; 93: 1373 – 61

7.      Amid PK, Shulman AG, Lichtenstein IL. Local anesthesia for inguinal hernia repair step-by-step procedure. Ann Surg 1994; 220:735–7.

8.      Kark AE, Kurzer MN, Belsham PA. Three thousand one hundred seventy-five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia. J Am Coll Surg 1998;186:447–55

9.      Schwartz’s Principles of Surgery, 8th edition, Ch. 36

10.  Russell RH: The saccular theory of hernia and the radical operation. Lancet 3: 1197, 1906

11.  Rodrigues-Junior AJ, de-Tolosa EM, de Carualho CA: Electron microscopic study on the elastic and elastic related fibres in the human fascia transversalis at different ages. Gegenbaurs Morphol Jahrb 1990; 136:645

12.  Cannon DJ, Read RC: Metastatic emphysema: A mechanism for acquiring inguinal herniation. Ann Surg 194:270, 1981

13.  Arnbjornsson E: Development of right inguinal hernia after appendectomy. Am J Surg 143:174, 1982

14.  Lee’s Synopsis of Anesthesia, 13th edition, Ch. 4.1

15.  Cattterall WA (2002): Molecular mechanisms of gating and drug block of sodium channels" – Novartis Found Symp 241: 206–32

16.  J. P. Howard Fee, J. G. Bovill – Pharma-cology for Anaesthesiologists, Ch. 5

17.  Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful Use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006;105:217-8

18.  Picard J, Meek T. Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob. Anaesthesia 2006;61:107-9

19.  Nyhus LM, Condon RE: Hernia, 3rd edition, Philadelphia: JP Lippincott, 1989

20.  Abrahamson J: Maingot’s Abdominal Operations, 10th edition, Appleton and Lange, 1997; 479-572

21.  Shouldice EE. The treatment of hernia. Ontario Med Rev 1953; 20:670

22.  McVay CB, Halverson K. Preperitoneal hernioplasty. In: Beahrs OH, Beart RW Jr, General Surgery Therapy. New York: John Wiley and Sons; 1981:10

23.  Abrahamson J, Eldar S. Primary and recurrent inguinal hernias – repair with nylon darn. Theor Surg 1987; 2:91

24.  Stoppa RE, Rives JL, et al. The use of Dacron in the repair of hernias of the groin. Surg Clin North Am 1984; 64:269

25.  Lichtenstein IL, Shulman AG, Amid PK. The cause, prevention, and treatment of recurrent groin hernia. Surg Clin North Am 1993; 73:529

26.  Ger R: The management of certain abdominal hernia by intra-abdominal closure of the neck of the sac. Preliminary communication. Ann R Coll Surg Engl 64:342, 1982

27.  van Veen RN, Mahabier C, Dawson I, Hop WC, Kok NF, Lange JF, Jeekel J - Spinal or local anesthesia in Lichtenstein hernia repair: a randomized controlled trial : Ann Surg.  2008; 247(3):428-33

28.  Nordin P, Zetterstrom H, Gunnarsson U, et al – Local, regional or general anesthesia in groin hernia repair: multicentre randomized trial. Lancet 2003; 362:853

29.  Uma Srivastava, Aditya Kumar, Surekha Saxena, Neeraj, Deepankar Raj Sehgal - Comparison of Local, Spinal and General Anaesthesia for Inguinal Hernia Repair: J Anesth Clin Pharmacology 2007; 23(2): 151-154

30.  P Sanjay, A Woodward - Inguinal hernia repair: local or general anaesthesia? : Ann R Coll Surg Engl 2007; 89: 497–503

31.  Callesen T, Bech K, Kehlet H – One Thousand Consecutive Inguinal Hernia Repairs Under Unmonitored Local Anesthesia: Anesth Analg 2001;93:1373–6

32.  Gnanalingham K, Misra B – Day case hernia repair under local versus general anaesthesia: patient preferences : Ambulatory Surgery Volume 6, Issue 4, October 1998, Pages 227-229

33.  Ezio Gianetta, Sonia Cuneo, Bruno Vitale, Giovanni Camerini, Paola Marini,  Mattia Stella, MD – Anterior Tension-Free Repair of Recurrent Inguinal Hernia Under Local Anesthesia – A 7-Year Experience in a Teaching Hospital : Ann Surg Vol. 231, No. 1, 132–136

34.  Young DV – Comparison of local, spinal and general anaesthesia for inguinal herniorrhaphy : Am J Surg 1987; 153: 560–3

35.  Bernia R, Hashemi F, Stryker SJ, et al – A comparison of general versus local anesthesia during inguinal herniorrhaphy : Surg Gynecol Obstet.1992;174:277–280

36.  Makuria T, Alexander-Williams J, Keighley MRB – Comparison between general and local anesthesia for repair of groin hernias : Ann Roy Coll Surg Engl. 1979;61:291–294

37.  Baskerville PA, Jarret PEM – Day case inguinal hernia : Ann R Coll Surg Engl 1983; 65: 224–5

38.  H Lau, F Lee - An audit of the early outcomes of ambulatory inguinal hernia repair at a surgical day-care centre : HKMJ 2000;6:218-20

39.  N. Masiira - Experience with day-care surgery in a Private Surgical Clinic in Nakuru, Kenya : East and Central African Journal of Surgery, 2001, Vol 6-02

40.  Dhumale R – Feasibility study of hernia surgery in a general practice setting : Br J Gen Pract 2004 August 1; 54(505): 604–607

41.  Bapat R; Kantharia CV; Ranka S; Bakshi G; Iyer A - Day care surgery in a public hospital set up : Bombay Hospital Journal. 2001 Apr; 43: 249-52

42.  Colin A. Pinnock, Ted Lin, Tim Smith, Robert Jones Fundamentals of Anesthesia, 2nd edition, Ch 7

43.  Amid PK, Lichtenstein IL. Long term result and current status of the Lichtenstein open tension-free hernioplasty. Hernia 1998; 2: 89–94.

44.  Amid PK, Shulman AG, Lichtenstein IL. Open tension free repair of inguinal hernias: the Lichtenstein technique. Eur J Surg 1996; 162: 447–53.

45.  Kark AE, Kurzer M, Waters KJ. Tension free hernia repair: review of 1098 cases using local anaesthesia in a day case unit. Ann R Coll Surg Engl 1995; 77: 299–304.

46.  Welsh DR, Alexander MA: The Shouldice repair. Surg Clin North Am 1993; 73: 451–69.

47.  Stobie B: Shouldice Hospital: dedicated to the repair of hernias. Can Oper Room Nurs J 1999; 17: 30–2.

48.  Kingsnorth AN, Porter C, Bennet DH. The benefit of a hernia service in a public hospital. Hernia 2000; 4: 1–5.

49.  Bailey and Love’s Short Practice of Surgery, 24th edition, Ch. 17.

Corresponding Author

Dr Amul Bhedi

Address: 12, Alok Residency, Opp. Vaikunth-2, Khodiyar Char Rasta,

New VIP Road, Vadodara- 390019.

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.