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Local Superior to Regional and General Anaesthesia for Hernia Repair
Lancet
09/15/2003
By Joene Hendry
Use of local anaesthesia compared with regional or general anaesthesia results in a shorter duration of hospital admission and less postoperative pain, as well as fewer micturition difficulties, in patients undergoing hernia repair.
Par Nordin, MD, Ostersund Hospital, Sweden, and colleagues randomised 616 adult patients undergoing hernia repair, while under local, regional, or general anaesthesia, at 10 participating hospitals. "Postoperative side-effects and prolonged hospital stay after groin hernia surgery are often related to the effects of anaesthesia," the authors note.
They analysed post-operative complications during the pre-discharge period and at 8 and 30 days post-discharge, and calculated surgery and anaesthesia duration, the length of post-operative hospital stay, and the time to normal activity on an intention to treat basis. The cohort was a mean age of 56 years and 98% were male. Hernia size was 0 to 3 cm in 31%, 4 to 7 cm in 59%, greater than 8 cm in 10%, and 11% of the cohort had scrotal hernias. Baseline characteristics were similar across groups.
Mean pain scores on a visual analog scale (VAS) were 1.8 in the local group compared with 3.0 and 3.3 in the regional and general groups, respectively. Mean nausea VAS scores were also significantly less in the local group at 1.1, compared with 1.3 in the regional and 1.7 in the general anaesthesia group.
None of the patients in the local anaesthesia group required catheterisation, compared with 29% in the regional and 8% in the general groups. Early post-operative pain that required opioid use was reported in 8% of the local group compared with 22% of the regional and 34% of the general anaesthesia group.
Patients receiving local anaesthesia had a mean duration of surgery of 69 minutes compared with 62 minutes for those under regional and 60 minutes for those under general anaesthesia. But, the mean time on anaesthesia was shorter for the local group, 90 minutes, compared with 100 minutes for the regional and 95 minutes for the general group. Mean hospital stay in hours was 3.1 in the local group and 6.2 in both the regional and general groups. Follow up at 8 and 30 days revealed no significant differences between groups for any of the endpoints.
"For almost all variables, local anaesthesia had much better results than did its alternatives," the authors note adding, "this advantage remained for length of postoperative hospital stay and for number of unplanned overnight admissions, which was only half the rate reported after regional and general anaesthesia." "Our results show," Dr. Nordin and colleagues conclude, "local anaesthesia has substantial advantages over regional and general anaesthesia."
Lancet 2003;362:853-58.
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