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Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Pere, Pertti Harju, Jukka Kairaluoma, Pekka Remes, Veikko Turunen, Päivi Rosenberg, Per H.
Description	Author Affiliation: Pere P ( Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine); Harju J ( Division of Gastrointestinal Surgery, Department of Surgery, University of Helsinki, 00014 University of Helsinki); Kairaluoma P ( Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine); Remes V ( Division of Gastrointestinal Surgery, Department of Surgery, University of Helsinki, 00014 University of Helsinki); Turunen P ( Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine); Rosenberg PH ( Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine.)
Abstract	STUDY OBJECTIVE: Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TIVA patients. DESIGN: Randomized, prospective trial. SETTING: University hospital day-surgery center. PATIENTS: 156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy. INTERVENTIONS: Patients were randomized to either LAI (lidocaine+ropivacaine), SPIN (bupivacaine+fentanyl) or TIVA (propofol+remifentanil). Perioperative Ringer infusion was 1.5mL/h. Urinary bladder was scanned before and after surgery. Interviews were performed on postoperative days 1, 7 and 90. MEASUREMENTS: Duration of surgery, duration of the patients' stay in the operating room and time until their readiness for discharge home. Patient satisfaction and adverse effects were registered. MAIN RESULTS: Surgery lasted longer in LAI group (median 40min) than in SPIN group (35min) (P=.003) and TIVA group (33min) (P<.001). Although surgery was shortest in TIVA group, TIVA patients stayed longer in the operating room than LAI patients (P=.001). Time until readiness for discharge was shorter in LAI group (93min) than in TIVA (147min) and SPIN (190min) groups (P<.001). Supplementary lidocaine infiltration was given to 32 LAI patients, and IV fentanyl to 29 LAI and 4 SPIN patients. Ephedrine was required in 34 TIVA, 5 LAI and 5 SPIN patients. One SPIN and three LAI patients had to be given TIVA and another SPIN patient LAI to complete the operations. Urinary retention was absent. Discomfort in the scar (26%) three months postoperatively was not anesthesia-related. CONCLUSIONS: Logistically, LAI was superior because of the fastest recovery postoperatively. The anesthetic techniques were adequate for surgery in all but a few LAI and SPIN patients. Lack of urinary retention was probably related to the small IV infusion volumes.
File Format	HTM / HTML
ISSN	09528180
Journal	Journal of Clinical Anesthesia
Volume Number	34
e-ISSN	18734529
Language	English
Publisher	Elsevier
Publisher Date	2016-11-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Anesthesiology
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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