J. Favela1, T. Phung2, M. Argo1, S. Huerta1,2 1University Of Texas Southwestern Medical Center,Dallas, TX, USA 2VA North Texas Health Care System,Dallas, TX, USA
Introduction:
Open inguinal hernia repair is one of the most common procedures done around the world and in the United States. While using general anesthesia has been the norm for many years, new anesthetic modalities such as local and regional anesthesia are gaining popularity. This is a retrospective chart review assessing the differences in morbidity as well as operative and perioperative time between local and general anesthesia in open inguinal hernia repairs (OIHR) all performed by a single surgeon at a single Veteran’s Hospital. We hypothesize the use of general anesthesia concurs no benefit when compared to local anesthesia when it comes to overall patient morbidity.
Methods:
A comprehensive chart review of all 1146 patients who underwent an OIHR performed by a single surgeon was completed. Parameters recorded included patient demographics (BMI, age), patient comorbidities, operative times (preoperative holding time, surgical time, operating room time, and Post Anesthesia Care Unit (PACU) time), and postoperative surveillance including (inguinodynia, recurrence, and morbidity). Patient morbidity was subdivided into distinct categories including: wound hematoma, infection, urinary retention, pain, and other. A Chi-Square analysis was completed to assess the difference between inguinodynia, recurrence, and morbidity in the two anesthesia groups. A paired two sample t-test was used assess the difference in operative and perioperative time.
Results:
Based on the analysis we conducted, there is no significant difference in recurrence (p = 0.297), inguinodynia (p = 0.467), or morbidity (p = 0.128) between local and general anesthesia. Within the morbidity group, only wound hematoma was significantly decreased in the local anesthetic group (p = 0.003). A significant decrease in the preoperative and postoperative time was observed when local anesthesia was utilized in place of general anesthesia. On average pre-operative holding times decreased by 16 minutes (p = 0.001). Postoperative (or PACU) time decreased by 37 minutes (p < 0.0001). Operative time decreased by an average of 8 minutes, but this was not statistically significant (p = 0.46).
Conclusion:
While this data set is limited to the experience of a single surgeon at a single hospital, there is sufficient evidence to suggest local anesthesia reduces preoperative and postoperative time and resources. Furthermore, local anesthesia does not appear to be inferior with regards to patient outcomes including: inguinodynia, recurrence, and other complications.