M. B. Argo1, J. G. Favela1, S. Huerta1 1University Of Texas Southwestern Medical Center,General Surgery,Dallas, TX, USA
Introduction: There continues to be variation in the choice of anesthetic technique for open inguinal hernia repair (OIHR) worldwide, which seems to be guided by patient’s satisfaction and surgeon’s preference. The factors determining the use of local anesthetic (LA) compared to spinal (SA) and general (GA) anesthesia remains equivocal as previous data has compared either SA or GA [all others (AO)] to LA. We hypothesize that outcomes and operative room times are superior with LA compared to AO for the repair of OIHR. The present study is an analysis of all randomized controlled trials (RCTs) in patients undergoing OIHR comparing LA to AO.
Methods: PubMed, MEDLINE, Ovid syntax from 1949 to Jan 2018 , the Cochrane Library, Google, ang Google Scholar were reviewed by two independent reviewers following PRISMA guidelines. We identified 73 potential manuscripts, following exclusion of papers that were not OIHR, did not include anesthesia type, and non-randomized trials, 16 RCT’s were available for inclusion. The parameters evaluated were short-term complications (urinary retention, wound infections, and hematomas), patient satisfaction, length of hospital stay (LOS), total surgical time, total operating room time, and postoperative pain. Review Manager 5.3 was used to test for overall effect between the included studies.
Results: The use of local anesthesia was favored in the majority of analyses. Overall complication rate favored LA (p=0.12), but only urinary retention was significantly decreased in LA (p=0.002). Both wound infection (p=0.12) and hematoma (p= 0.67) favored OA. Patient satisfaction favored the use of LA (p=0.10). Total surgical time was increased in LA versus OA (p = 0.86; 95% CI [-7.2,8.6]), but the overall operating room time was significantly decreased when LA was used (p<0.001; 95% CI [-18.4,-7.1]). Seven of the ten studies that recorded LOS reported a significant decrease when LA was used.
Conclusion: This meta-analysis demonstrates that LA is a well-tolerated anesthetic approach for OIHR. OR times and urinary retentions are significantly improved with LA vs.AO. LA improves the economic burden by decreasing operating room time and decreasing overall intraoperative and early postoperative costs, which is significant for a procedure performed so frequently.