O'Dwyer Patrick J, Serpell Michael G, Millar Keith, Paterson Caron, Young David, Hair Alan, Courtney Carol-Ann, Horgan Paul, Kumar Sudhir, Walker Andrew, Ford Ian
University Department of Surgery, Western Infirmary and Royal Infirmary, Glasgow G211 6NT, Scotland, UK.
Ann Surg. 2003 Apr;237(4):574-9. doi: 10.1097/01.SLA.0000059992.76731.64.
To compare patient outcome following repair of a primary groin hernia under local (LA) or general anesthesia (GA) in a randomized clinical trial.
LA hernia repair is thought to be safer for patients, causes less postoperative pain, cost less, and is associated with a more rapid recovery when compared with the same operation performed under GA.
All patients presenting to three surgeons during the study period with a primary groin hernia were considered eligible. Outcome parameters measured including tests of vigilance, divided attention, sustained attention, memory, cognitive function, pain, return to normal activity, and costs.
Two hundred seventy-nine patients were randomized to LA or GA hernia repair; 276 of these had an operation, with 138 participants in each group. At 6, 24, and 72 hours postoperatively there were no differences in vigilance or divided attention between the groups. Similarly, memory, sustained attention, and cognitive function were not impaired in either group. Although physical activity was significantly impaired at 24 hours, this and return to usual social activities were similar in both groups. While patients in the LA group had significantly less pain on moving, at 6 hours they were less likely to recommend the same operation to someone else. GA hernia repair cost 4% more than the same operation under LA.
There are no major differences in patient recovery after LA or GA hernia repair. Patients should be offered a choice of anesthesia, LA or GA, for repair of their groin hernia.
在一项随机临床试验中比较局部麻醉（LA）或全身麻醉（GA）下原发性腹股沟疝修补术后的患者预后。
与在全身麻醉下进行相同手术相比，局部麻醉下的疝修补术被认为对患者更安全，术后疼痛更少，成本更低，且恢复更快。
在研究期间，所有向三位外科医生就诊的原发性腹股沟疝患者均被视为符合条件。测量的结果参数包括警觉性测试、注意力分散、持续注意力、记忆力、认知功能、疼痛、恢复正常活动情况及成本。
279例患者被随机分为局部麻醉或全身麻醉疝修补组；其中276例接受了手术，每组138名参与者。术后6小时、24小时和72小时，两组间的警觉性或注意力分散情况无差异。同样，两组的记忆力、持续注意力和认知功能均未受损。虽然术后24小时身体活动明显受限，但两组在这方面以及恢复日常社交活动方面情况相似。虽然局部麻醉组患者活动时疼痛明显较轻，但在术后6小时，他们向他人推荐相同手术的可能性较小。全身麻醉疝修补术的费用比局部麻醉下的相同手术高4%。
局部麻醉或全身麻醉疝修补术后患者恢复情况无重大差异。对于腹股沟疝修补术，应向患者提供局部麻醉或全身麻醉的选择。
