Is Open Hernia Repair Really Done Under Local Anesthesia
- Research article
- Open Access
- Published:
Emergency inguinal hernia repair under local anesthesia: a 5-year feel in a teaching hospital
BMC Anesthesiology volume xvi, Article number:17 (2015) Cite this commodity
Abstract
Background
Local anesthesia (LA) has been reported to be the best choice for constituent open inguinal hernia repair because it is price efficient, with less mail-operative hurting and enables more rapid recovery. Nonetheless, the office of LA in emergency inguinal hernia repair is still controversial. The aim of this study is to investigate the safety and effectiveness of LA in emergency inguinal hernia repair.
Methods
All patients underwent emergency inguinal hernia repair in our hospital between January 2010 and April 2022 were analyzed retrospectively in this written report. Patients were divided into LA and general anesthesia (GA) group co-ordinate to the general weather condition of the patients decided by anesthetists and surgeons. The outcome parameters measured included time to recovery, early on and late postoperative complications, total expense and recurrence.
Results
This report included a total of 90 patients from 2010 to 2022. 32 patients (35.half-dozen %) were performed under LA, and 58 (64.4 %) were performed nether GA. LA group has less cardiac complications (P = 0.044) and respiratory complications (P = 0.027), shorter ICU stay (P = 0.035) and infirmary stay (P = 0.001), lower cost (P = 0.000) and faster recovery time (P = 0.000) than GA grouping.
Conclusion
LA could provide effective anesthesia and patient safety in emergency inguinal hernia repair.
Peer Review reports
Groundwork
With progresses in surgical techniques and anesthetic methods, elective inguinal hernia repair surgery has become a condom outpatient procedure that carries favorable outcomes [1]. All the same, when it comes to emergency hernia repair surgery, things are different. Compared with elective surgery, postoperative bloodshed tin can increase seven-fold in emergency operations, and 20-fold if bowel resection was undertaken [2]. With fewer preoperative preparations and more difficult local anatomy, these patients are more likely at high run a risk of postoperative complication, or even death [iii, four].
Local anesthesia (LA) is one of the most commonly used anesthetic methods in inguinal hernia repair [5–7]. LA is recommended for inguinal hernia repair in elderly patients and patients with co-morbidities (form C) by the Association of Surgeons of Bully Britain and Ireland (ASGBI) [eight]. Moreover, European Hernia Social club Guideline (EHS) recommended that patients with ASA (American Surgical Clan) preoperative evaluation of grade iii or 4 tin consider day surgery with LA. Notwithstanding, young anxious patients, with morbid obesity, incarcerated hernia should be excluded from performance under LA [nine].
From 2008, our hospital started to perform inguinal hernia repair under LA. Compared with full general anesthesia (GA), LA showed increased safety, better postoperative pain control, less postoperative complexity, shorter recovery catamenia, and reduced price. Since 2010, our hospital has begun to perform emergency hernia surgery under LA. The aim of this study is to investigate the condom and effectiveness of LA in an emergency inguinal hernia surgery by evaluating related outcomes.
Method
This is a retrospective study. We included all patients diagnosed as an incarcerated inguinal hernia and underwent an emergency inguinal hernia repair surgery in our infirmary betwixt Jan 2010 and Apr 2022. All the patients' data required was collected from electronic medical records. The drove and analysis were approved by the Ethics Committee of Ren Ji hospital.
Surgeons and surgical procedures
Emergency inguinal hernia repairs nether LA were performed past ii experienced attending surgeons who had performed at to the lowest degree 50 constituent cases before. Operations under GA were performed by other three experienced attention surgeons in our department.
Data of patients were excluded if the contents of hernia sacs returned spontaneously subsequently the anesthesia before operation started. There was no other exclusion criterion in this report. If no bowel resection was performed, tension-gratis mesh repair were employed. If strangulated hernia was clearly diagnosed, tissue of strangulation was needed to be removed and non-mesh repair was used to avoid the loftier risk of infection after bowel resection.
Cefotetan was used as prophylactic antibiotics routinely. Aztreonam was utilized if patients were allergic to cephalosporins.
Anesthesia
The selection of anesthesia means (LA or GA) was decided past anesthetists and surgeons according to the general weather of the patients.
In grouping GA, anesthesia was induced with propofol 2 mg/kg and fentanyl 0.1–0.2 mg intravenously. Inhalation anesthesia was given at the aforementioned time with a mixture of oxygen and isoflurane 1–ii % through an intubation.
Patients in LA group received the local infiltration technique. A mixture of 2 % lidocaine 20 ml and 0.nine%NS 30 ml was used as the local anesthetic. Patients required actress analgesia during the surgery were given xx–40 mg parecoxib sodium intravenously. Conversion to GA was performed if LA was intolerant for patient, which was evaluated by both anesthetists and surgeons.
Patients in both groups were prescribed tramadol 100 mg per 24 h for the first one–2 days postoperative.
Postoperative recovery
In this study, "time to eat" is the post-operative time when patients were able to have semi-liquid without an intolerable nausea or vomiting. Patients were likewise asked to get up from the bed and walk a standard distance before they returned to their bed as soon as possible later the operation, which was recorded equally "time to airing".
Patients were required for a regular follow-up in our outpatient clinic afterward discharge (7, thirty and xc days post-operatively), where all complications, including wound complications, scrotal edema, retention of urine and recurrence, were recorded.
Economic science
A data drove form recording all aspects of hospital resource was used in the study. It included the data on performance and staff toll, costs of hospital stay (including stay in ICU), and other healthcare costs, including toll of complications.
Statistical analysis
Statistical analysis was performed using SPSS 19 software. Between-group differences were analyzed using two-sample t-exam. When there was uncertainty about the validity of parametric assumptions, nonparametric tests were performed. A chi-square test or Fisher'southward Exact Exam, every bit appropriate, was used to clarify categorical information. A significance level of 0.05 was used in this study.
Result
In this report, patients who underwent emergency hernia repair between January 2010 and April 2022 were included. 92 patients were enrolled initially. Two were excluded because contents of hernia sacs returned spontaneously after the anesthesia before the operation started (one with LA and one with GA). At that place were no other exclusion criteria in this study. Thus, 90 patients diagnosed as incarcerated inguinal hernia and underwent emergency inguinal hernia repair were included in the final analysis. There were 32 patients (twenty men and 12 women) in LA grouping and 58 patients (45 men and 13 women) in GA group. All patients received regularly follow-up (7 and 30 days after surgery) and 87 patients received the regularly follow-up of ninety days subsequently the surgery (including 26 patients followed by telephone).
General status
General condition of all patients was shown in Table i. The mean age of patients in GA group was 77.4 ± 12.7 years (range from 30 to 94), and 79.iii ± 17.9 years (range from 30 to 99) in LA group (P = 0.554). xv.6 % of all patients had the duration of symptoms shorter than 6 h; 23.3 % between 6 to 12 h; 17.8 % between 12 to 24 h; 43.three % longer than 1 day. The duration of symptoms in LA group was longer than that in GA group (P = 0.013). LA group had 1 instance of recurrent hernia and nine cases were in grouping GA. LA group had a college ASA Form than that of GA grouping (P = 0.007).
Surgical procedure
Ane case with bowel resection was performed under LA. In GA group, seven cases (included one converted from LA) had bowel resection. In LA group, 31 patients underwent mesh repairs, except the cases with bowel resection. In GA group, l patients received mesh repairs while eight received tissue repairs (included all 7 cases with bowel resection). In two cases of LA group and two cases of GA group, the incarcerated hernia sacs returned spontaneously during the operation.
Postoperative recovery
Patients in LA group had a shorter infirmary stay than those in GA grouping (4.31 ± i.58 vs 5.88 ± ii.82 days, P = 0.001). LA group also had shorter ICU stay, time to eat, fourth dimension to airing and less full costs. All the differences were statistical significant and presented in Table 2.
Complications
A summary of complications of 2 groups was presented in Tabular array 2. LA grouping had fewer respiratory and cardiovascular complications than the GA group. 87 patients received a three-month regular follow-upwardly after discharge. No recurrence was observed.
Discussion
GA is widely used in hernia repair. It tin can provide the surgeon with optimal operating condition in terms of patient immobility and a satisfactory muscular relaxation [10]. GA has been proved to exist a good choice in hernia repair surgery, both in constituent and emergency operations. In elective operations, LA has showed a lower gamble compared to GA [eleven, 12]. But the role of LA in emergency inguinal hernia repair is still controversial [viii, 9, 13, 14].
Intraoperative hurting seems to be the virtually common reason for dissatisfaction with LA. Ane written report demonstrated that infiltration was painful and 8.5 % of patients experienced pain intraoperatively [fifteen]. Incarcerated hernia e'er has a complicated anatomy, pain and tension may result in an unsatisfactory muscular relaxation. In such status, many surgeons worried that emergency operations might overdose on local anesthetics. With improvement in surgical technique, surgeons became knowledgeable regarding the anatomy of the inguinal region too as the awarding of LA. The indication of LA application was widened footstep past step. In this report, we tried to apply LA in emergency incarcerated hernia repair and evaluate its feasibility.
LA of inguinal hernia repair reported in the literature include "one step procedure" LA [16], ultrasound-guided transversus abdominis plane block and unilateral paravertebral block [17]. The argument near the "best" type and ratio of the anesthetics has never stopped [eighteen–21]. In this study, we followed a "step past step technique", which was first reported by Amid in 1994 [22]. In two cases, the surgeon even finished the contralateral inguinal hernia repair with the given mixture. Our study performed 32 cases in LA successfully (33 in full). There was but one instance converted to GA, in which bowel resection was performed. So LA is viable for emergency incarcerated hernia if the possibility of bowel resection is limited. In other two cases, we observed that the contents of hernia sacs returned spontaneously, which showed that LA might also take the effect of tissue relaxation.
In our report, the patient characteristics betwixt ii groups were different. Patients in LA group had a longer duration of symptoms and a higher ASA grade. This is because the grouping was nonrandomized. Surgeons and anesthetists tended to grouping the patients with serious comorbid illness in LA to avoid adventure of complications of GA. Meanwhile patients who suffered longer incarcerated fourth dimension and likely got bowel resection might receive GA according to medical staff. Even in this situation, our report yet revealed significant advantages for LA in postoperative cardiopulmonary complications. LA can allow patients to start eating earlier and have early ambulation, therefore reducing the time of nutritional support and avoiding postoperative cardiopulmonary infection and finally reducing hospital costs and hospital stays. Our report found that patients in LA group had advantages compared to those in the GA grouping on ICU residence time, total infirmary stay and total hospital cost. It was demonstrated that inguinal hernia repair in incarcerated hernia patients is viable under LA.
LA also has its disadvantages. First, intraoperative pain is one of the most common reasons for dissatisfaction with LA. In our written report, LA was performed not merely by the surgeon only besides monitored by an anesthetist, who played an of import part in keeping prophylactic of the operation. In some difficult cases, extra analgesic or sedative drugs given intravenously by the anesthetist can meliorate the success rate of LA. Second, whether meshes tin can exist applied in the emergency repair surgery under LA is still inconclusive [23, 24]. Our previous report showed that prosthetic mesh could be used if no bowel resection performed, duration of symptoms less than 24 h and fluid hernia sac was articulate [25]. In this study, tension-costless repair with meshes was applied in 81 cases based on the above principles. Tertiary, H. Kehlet reported that local anesthesia was ane of the adventure factors for recurrence after groin hernia repair [26]. Although no recurrence case was observed in our study with a three-month follow-up, a longer time follow-upwardly period is necessary.
Our study has its limitations. For this is a retrospective study, the lack of randomization is a major problem. We promise to have more conclusive results in further studies, which can exist well-designed randomized controlled trials with larger sample size.
Conclusion
LA could provide constructive anesthesia and patient safety in emergency inguinal hernia repair, especially when the possibility of bowel resection is limited. Farther prospective studies are needed to confirm this finding.
Consent
Written informed consent was obtained from the patient for the publication of this study and any accompanying images.
References
-
Lomanto D, Cheah WK, Faylona JM, et al. Inguinal hernia repair: toward Asian guidelines. Asian J Endosc Surg. 2022;eight(one):16–23.
-
Kulah B, Duzgun AP, Moran M, et al. Emergency hernia repairs in elderly patients. Am J Surg. 2001;182(5):455–ix.
-
Kjaergaard J, Bay-Nielsen M, Kehlet H. Bloodshed post-obit emergency groin hernia surgery in Kingdom of denmark. Hernia. 2010;14(4):351–5.
-
Rosenberg J, Bisgaard T, Kehlet H, et al. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Balderdash. 2022;58(2):C4243.
-
Nordin P, Zetterstrom H, Carlsson P, et al. Price–effectiveness analysis of local, regional and general anaesthesia for inguinal hernia repair using data from a randomized clinical trial. Br J Surg. 2007;94(4):500–v.
-
O'Dwyer PJ, Serpell MG, Millar K, et al. Local or general anesthesia for open hernia repair: a randomized trial. Ann Surg. 2003;237(4):574–nine.
-
Reece-Smith AM, Maggio AQ, Tang TY, et al. Local anaesthetic vs. general anaesthetic for inguinal hernia repair: systematic review and meta-analysis. Int J Clin Pract. 2009;63(12):1739–42.
-
David South, Martin K, et al. Groin hernia guidelines, Association of Surgeons of Britain and Republic of ireland, Available at: http://www.asgbi.org.uk/download.cfm?docid=21BC920F-290E-4CDE-B415CA77DFF1E0A0
-
Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Lodge guidelines on the treatment of inguinal hernia in developed patients. Hernia. 2009;13(4):343–403.
-
Sanjay P, Woodward A. Inguinal hernia repair: local or general amazement? Ann R Coll Surg Engl. 2007;89(five):497–503.
-
Amato B, Compagna R, Della Corte GA, et al. Feasibility of inguinal hernioplasty under local anaesthesia in elderly patients. BMC Surg. 2022;12 Suppl one:S2.
-
Nordin P, Zetterstrom H, Gunnarsson U, Nilsson Eastward. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet. 2003;362:853–eight.
-
Nordin P, Hernell H, Unosson G, et al. Type of anaesthesia and patient acceptance in groin hernia repair: a multicentre randomised trial. Hernia. 2004;viii:220–five.
-
Teasdale C, McCrum AM, Williams NB, et al. A randomised controlled trial to compare local with full general anaesthesia for short-stay inguinal hernia repair. Ann R Coll Surg Engl. 1982;64:238–42.
-
Kurmann A, Fischer H, Dell-Kuster S, et al. Effect of intraoperative infiltration with local anesthesia on the development of chronic pain subsequently inguinal hernia repair: a randomized, triple-blinded, placebo-controlled trial. Surgery. 2022;157(one):144–54.
-
Dabić D, Perunicić 5, Marić B. "Ane pace procedure" local anaesthesia for inguinal hernia repair in ambulatory surgery atmospheric condition--district general hospital experience. Acta Chir Iugosl. 2022;59(i):87–93.
-
Bhattacharya P, Mandal MC, Mukhopadhyay S, et al. Unilateral paravertebral block: an alternative to conventional spinal anaesthesia for inguinal hernia repair. Acta Anaesthesiol Scand. 2010;54(ii):246–51.
-
Compagna R, Vigliotti G, Coretti One thousand, et al. Comparative report between Levobupivacaine and Bupivacaine for hernia surgery in the elderly. BMC Surg. 2022;12 Suppl 1:S12.
-
Milone M, Di Minno MN, Musella K, et al. Outpatient inguinal hernia repair under local anaesthesia: feasibility and efficacy of ultrasound-guided transversus abdominis plane block. Hernia. 2022;17(6):749–55.
-
Kulacoglu H, Ergul Z, Esmer AF, et al. Percutaneous ilioinguinal-iliohypogastric nervus block or step-past-stride local infiltration anesthesia foringuinal hernia repair: what cadaveric autopsy says? J Korean Surg Soc. 2022;81(6):408–13.
-
De Sá Ribeiro FA, Padron F, Castro TD, et al. Inguinal hernia repair with local anesthesia in the outpatient. Rev Col Bras Cir. 2010;37(half-dozen):397–402.
-
Amid PK, Shulman AG, Lichtenstein IL. Open "tension-free" repair of inguinal hernias: the Lichtenstein technique. Eur J Surg. 1996;162:447–53.
-
Paajanen H, Varjo R. Ten-yr audit of Lichtenstein hernioplasty nether local anaesthesia performed by surgical residents. BMC Surg. 2010;4(10):24.
-
De Martino A, Testi Westward, Cirianni D, et al. Incarcerated inguinal hernia in elderly: personal tension-gratis hernioplastic technique. Ann Ital Chir. 2007;78(3):221–5.
-
Yang L, Wang H, Liang X, et al. Leaner in hernia sac: an important take chances fact for surgical site infection afterward incarcerated hernia repair. Hernia. 2022;19(2):279–83.
-
Kehlet H, Bay-Nielsen M. Local amazement as a risk factor for recurrence later groin hernia repair. Hernia. 2008;12(v):507–9.
Acknowledgement
This work was supported by the National Science Foundation of China (81072011, 81272748, and 81472240), Foundation of Science and Technology Commission of Shanghai Municipality (12XD1403400), and Foundation of Shanghai Municipal Health Agency (XBR2011035).
Writer information
Affiliations
Respective author
Additional information
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
TC and YZ participated in the design of the study, drafted the manuscript and performed the statistical analysis. HW, QN, LY, and QL: collected data, performed the statistical analysis and helped to draft the manuscript. JW conceived of the report, and participated in its design and coordination. All authors read and approved the concluding manuscript.
Rights and permissions
Open Admission This article is distributed nether the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted utilize, distribution, and reproduction in whatever medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Eatables license, and bespeak if changes were made. The Artistic Eatables Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the information made available in this article, unless otherwise stated.
Reprints and Permissions
Nearly this article
Cite this article
Chen, T., Zhang, Y., Wang, H. et al. Emergency inguinal hernia repair under local anesthesia: a five-twelvemonth experience in a education hospital. BMC Anesthesiol 16, 17 (2015). https://doi.org/10.1186/s12871-016-0185-2
-
Received:
-
Accepted:
-
Published:
-
DOI : https://doi.org/ten.1186/s12871-016-0185-ii
Keywords
- Incarcerated inguinal hernia
- Local anesthesia
- Safety
- Effective
Is Open Hernia Repair Really Done Under Local Anesthesia,
Source: https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-016-0185-2
Posted by: owenhiout1981.blogspot.com
0 Response to "Is Open Hernia Repair Really Done Under Local Anesthesia"
Post a Comment