Although repair of groin hernia is ...

Although repair of groin hernia is the same of the most common surgical transactions there is little consensus about the optimal form of anesthesia. Nordin and colleagues manner of lifeed a randomized controlled trial of local, regional, and general anesthesia in 616 patients undergoing surgery at 10 nonteaching hospitals in Sweden.

All patients 18 years or older who had been admitted for elective or imperative repair of a unilateral inguinal hernia were eligible for the studious mood Reasons for exclusion included returning hernia, pregnancy, bleeding abnormalities, or conditions that preclud the use of general or regional anesthesia. Patients were assigned randomly to common of three types of anesthesia. The participating surgeon were released to use their preferred open-repair technique on the other hand were required to use nonabsorbable line of junctions On days 8 and 30 after surgery patients were asked to undivided a questionnaire about pain, analgesic use, daily activities, and use of health services before hospital discharge within 30 days of surgery The researchers also tracked duration of anesthesia and surgery detail of hospital stay, and days until patients resum normal activity.

The 209 patients randomized to local anesthesia did not differ significantly from the 203 patients randomized to regional anesthesia or the 204 patients randomized to general anesthesia in age, carcass mass index, type of work, size of hernia, or preoperative pain. Of these patients, 15 were women and four were pass cases. Four patients who received local anesthesia and 19 patients who received regional anesthesia were renewed to general anesthesia, mainly because they required excessive sedation during the operation Among the three groups, the images of surgery were comparable, and no serious perioperative complications occurred

Patients receiving local anesthesia reported significantly les pain and nausea postoperatively than the other arranges Opiates were given to solitary 8 percent of patients receiving local anesthesia, compared with 22 percent of patients receiving regional anesthesia and 34 percent of patients receiving general anesthesia. No patients in the local anesthesia collection required catheterization for postoperative urinary point in disputes although this step was required in 8 percent of patients following administration of general anesthesia and in 29 percent following administration of regional anesthesia. Duration of anesthesia and hospital stay were significantly shorter in patients who received local anesthesia, nevertheless operating times were longer. The mean time to go [i]or[/i] come back to normal work and leisure activities was similar among the groups

The authors gather that local anesthesia has considerable advantages from one side of to the other regional or general anesthesia in the repair of groin hernia. In this subject of attention general surgeons from district hospitals were instructed in local anesthesia techniques during a one-day course before the trial. The researchers emphasize that virtuous outcomes and a lower rate of general anesthesia use can be achieved by dint of general surgeons in nonspecialty centers

ANNE D WALLING, MD

Nordin P et al. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet September 13 2003;362:853-8

COPYRIGHT 2004 American Academy of Family Physicians

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