Groin Hernia Repair: Anesthesia
Tóm tắt
The choice of anesthesia for groin hernia repair is between general, regional (epidural or spinal), and local anesthesia. Existing data from large consecutive patient series and randomized studies have shown local anesthesia to be the method of choice because it can be performed by the surgeon, does not necessarily require an attending anesthesiologist, translates into the shortest recovery (bypassing the postanesthesia care unit), has the lowest cost, and has the lowest postoperative morbidity regarding risk of urinary retention. Spinal anesthesia has no documented benefits for this small operation and should be avoided owing to the risk of rare neurologic side effects and the high risk of urinary retention. General anesthesia with short-acting agents may be a valid alternative when combined with local infiltration anesthesia, although an anesthesiologist is required. Despite sufficient scientific data to support the choice of anesthesia, large epidemiologic and nationwide information from databases show an undesirable high (about 10–20%) use of spinal anesthesia and low (about 10%) use of local infiltration anesthesia. Surgeons and anesthesiologists should therefore adjust their anesthesia practices to fit the available scientific evidence.
Tài liệu tham khảo
Kingsnorth A, LeBlanc K. 2003. Hernias: inguinal, incisional Lancet. 362:1561–1571
Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 2005 (in press)
Hair A, Duffy K, Mclean J, et al. 2000. Groin hernia repair in Scotland Br. J. Surg. 87:1722–1726
Nordin P, Haapaniemi S, van Der Linden W, et al. 2004. Choice of anesthesja and risk of reoperation for recurrence in groin hernia repair Ann. Surg. 240:187–192
Bay-Nielsen M, Kehlet H, Strand L, et al. 2001. Quality assessment of 26,304 herniorrhaphies in Denmark; a nationwide questionnaire study Lancet, 358:1124–1128
Kehlet H, Bay-Nielsen M. Anaesthetic practice for groin hernia repair: a nationwide study in Denmark 1998–2003. Acta Anaesthesiol Scand 2005 49: 143–146
Kark AE, Kurzer MN, Belsham PA. 1998. 3175 Primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia J. Am. Coll. Surg. 186:447–455
Amid PK, Schulman AG, Lichtenstein IL. 1994. Local anesthesia for inguinal hernia repair: step-by-step procedure Ann. Surg. 220:735–737
Glassow F. 1976. Short-stay surgery (Shouldice technique for repair of inguinal hernia) Ann. R. Coll. Surg. Engl. 58:133–139
Callesen T, Bech K, Kehlet H. 2001. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia Anesth. Analg. 93:1373–1376
Kingsnorth AN, Bowley DMG, Porter C. 2003. A prospective study of 1000 hernias: results of the Plymouth Hernia Service Ann. R. Coll. Surg. Engl. 85:18–22
Robbins AW, Rutkow IM. 1998. Mesh plug repair and groin hernia surgery Surg. Clin. North Am. 78:1007–1023
Kehlet H, White PF. 2001. Optimizing anesthesia for inguinal hemiorrhaphy: general, regional or local anesthesia? Anesth. Analg. 93:1367–1369
Heidemann Andersen F, Nielsen K, et al. combined ileoinguinal blockade and infiltration anaesthesia for inguinal hemiorrhaphy. Br. J. Anaesth. 2005 94: 520–523
Callesen T, Bech K, Kehlet H. 2001. Feasibility of local infiltration anaesthesia for recurrent groin hernia repair Eur. J. Surg. 167:851–854
Jensen P, Mikkelsen T, Kehlet H. 2002. Postherniorrhaphy urinary retention: effect of local, regional and general anesthesia; a review Reg. Anesth. Pain Med. 27:612–617
Nordin P, Zetterström H, Gunnarsson U, et al. 2003. Local, regional or general anaesthesia in groin hernia repair: multicentre randomised trial Lancet 362:853–858
Özgün H, Kurt MN, Kurt I, et al. 2002. Comparison of local, spinal and general anaesthesia for inguinal hemiorrhaphy Eur. J. Surg. 168:455–459
Gönüllü NN, Cubukcu A, Alponat A. 2002. Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial Hernia 6:29–32
Aasbø V, Thuen A, Ræder J. 2002. Improved long-lasting postoperative analgesia, recovery function and patient satisfaction after inguinal hernia repair with inguinal field block compared with general anesthesia Acta Anaesthesiol. Scand. 46:647–678
Song D, Greilich B, White PF, et al. 2000. Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphy Anesth. Analg. 91:876–881
Nordin P, Hernell H, Unosson M, et al. 2004. Type of anaesthesia and patient acceptance in groin hernia repair: a multicentre randomised trial Hernia 8:220–225
O’Dwyer P, Serpell MG, Millar K, et al. 2003. Local or general anesthesia for open hernia repair: a randomised trial Ann. Surg. 237:574–579
Kendell J, Wildsmith JAW, Gray IG. 2000. Costing anaesthetic practice; an economic comparison of regional and general anaesthesia for varicose vein and inguinal hernia surgery Anaesthesia 55:1106–1126
Callesen T, Bech K, Kehlet H. 1998. The feasibility, safety and cost of infiltration anaesthesia for hernia repair Anaesthesia 53:31–35
Sørensen LT, Friis E, Jørgensen T, et al. 2002. Smoking is a risk factor for recurrence of groin hernia World J. Surg. 26:397–400
Kingsnorth AN, Britton BJ, Morris BJ. 1981. Recurrent inguinal hernia after local anaesthetic repair Br. J. Surg. 68:273–275
Møiniche S, Kehlet H, Dahl JB. 2002. A qualitative and quantitative systematic review of pre-emptive analgesia for postoperative pain relief: the role of timing of analgesia Anesthesiology 96:725–741
Klein SM, Pietrobon R, Nielsen KC, et al. 2002. Paravertebral somatic nerve block compared with peripheral nerve blocks for outpatient inguinal herniorrhaphy Reg. Anesth. Pain Med. 27:476–480
Moen V, Dahlgren N, Irestedt L. 2004. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999 Anesthesiology 101:950–959
Mulroy MF, Burgess FW, Emanuelsson BM. 1999. Ropivacaine 0.25% and 0.5%, but not 0.125% provide effective wound infiltration analgesia after outpatient hernia repair, but with sustained plasma drug levels Reg. Anesth. Pain Med. 24:136–141
Kehlet H, Dahl JB. 2003. Spinal anaesthesia for inguinal hernia repair? Acta Anaesthesiol Scand. 47:1–2