Am Fam Physician. 2004 Apr 1;69(7):1762.
Although repair of groin hernia is one of the most common surgical procedures, there is little consensus about the optimal form of anesthesia. Nordin and colleagues conducted a randomized controlled trial of local, regional, and general anesthesia in 616 patients undergoing surgery at 10 nonteaching hospitals in Sweden.
All patients 18 years or older who had been admitted for elective or urgent repair of a unilateral inguinal hernia were eligible for the study. Reasons for exclusion included recurrent hernia, pregnancy, bleeding abnormalities, or conditions that precluded the use of general or regional anesthesia. Patients were assigned randomly to one of three types of anesthesia. The participating surgeons were free to use their preferred open-repair technique but were required to use nonabsorbable sutures. On days 8 and 30 after surgery, patients were asked to complete a questionnaire about pain, analgesic use, daily activities, and use of health services before hospital discharge within 30 days of surgery. The researchers also tracked duration of anesthesia and surgery, length of hospital stay, and days until patients resumed normal activity.
The 209 patients randomized to local anesthesia did not differ significantly from the 203 patients randomized to regional anesthesia or the 204 patients randomized to general anesthesia in age, body mass index, type of work, size of hernia, or preoperative pain. Of these patients, 15 were women and four were emergency cases. Four patients who received local anesthesia and 19 patients who received regional anesthesia were converted to general anesthesia, mainly because they required excessive sedation during the procedure. Among the three groups, the types of surgery were comparable, and no serious perioperative complications occurred.
Patients receiving local anesthesia reported significantly less pain and nausea postoperatively than the other groups. Opiates were given to only 8 percent of patients receiving local anesthesia, compared with 22 percent of patients receiving regional anesthesia and 34 percent of patients receiving general anesthesia. No patients in the local anesthesia group required catheterization for postoperative urinary problems, although this step was required in 8 percent of patients following administration of general anesthesia and in 29 percent following administration of regional anesthesia. Duration of anesthesia and hospital stay were significantly shorter in patients who received local anesthesia, but operating times were longer. The mean time to return to normal work and leisure activities was similar among the groups.
The authors conclude that local anesthesia has considerable advantages over regional or general anesthesia in the repair of groin hernia. In this study, general surgeons from district hospitals were instructed in local anesthesia techniques during a one-day course before the trial. The researchers emphasize that good outcomes and a lower rate of general anesthesia use can be achieved by general surgeons in nonspecialty centers.
Nordin P, et al. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet. September 13, 2003;362:853–8.
Copyright © 2004 by the American Academy of Family Physicians.
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