Sanjay P, Woodward A
Department of Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Ann R Coll Surg Engl. 2009 Nov;91(8):677-80. doi: 10.1308/003588409X12486167521073. Epub 2009 Sep 25.
Local anaesthetic inguinal hernia repair may be technically demanding. There are minimal data regarding the outcomes of local anaesthetic hernia repair by trainees in comparison with consultants.
All consecutive local anaesthetic repairs performed by trainees and one consultant over a 9-year period were reviewed. Operation time, volume of local anaesthetic used, early and long-term complications were assessed. A postal survey was conducted to assess chronic groin pain and satisfaction rates.
A total of 369 repairs were reviewed of which 265 repairs were performed by the consultant and 104 by trainees. The male-to-female ratio was 25:1 and the median age of the study group was 61 years (range, 18-93 years). The volume of local anaesthetic used was significantly higher for trainees than the consultant (42 ml versus 69 ml; P = 0.03). The operative time for the consultant and the trainees was 35 min and 40 min (P = 0.8). The day-case rate was higher for the consultant than the trainees (84% versus 69%; P = 0.02). Three patients operated by trainees required conversion to a general anaesthetic repair. No difference was noted in chronic groin pain (consultant 28% versus trainees 32%; P = 0.52) on the postal survey. The median follow-up was 5 years (range, 2-7 years).
Local anaesthetic inguinal hernia repair can be performed safely by surgical trainees under consultant supervision with minimal short- and long-term morbidity. A large volume dilute solution of Lignocaine and Marcaine is recommended when hernia repair is undertaken by trainees.
局部麻醉下腹股沟疝修补术在技术上可能具有挑战性。与顾问医生相比，关于实习医生进行局部麻醉疝修补术的结果的数据极少。
回顾了实习医生和一名顾问医生在9年期间进行的所有连续性局部麻醉修补术。评估了手术时间、局部麻醉药用量、早期和长期并发症。进行了一项邮寄调查以评估慢性腹股沟疼痛和满意率。
共回顾了369例修补术，其中顾问医生进行了265例修补术，实习医生进行了104例。男女比例为25:1，研究组的中位年龄为61岁（范围18 - 93岁）。实习医生使用的局部麻醉药用量显著高于顾问医生（42毫升对69毫升；P = 0.03）。顾问医生和实习医生的手术时间分别为35分钟和40分钟（P = 0.8）。顾问医生的日间手术率高于实习医生（84%对69%；P = 0.02）。3例由实习医生手术的患者需要转为全身麻醉修补术。邮寄调查中慢性腹股沟疼痛方面未发现差异（顾问医生为28%，实习医生为32%；P = 0.52）。中位随访时间为5年（范围2 - 7年）。
在顾问医生的监督下，外科实习医生可以安全地进行局部麻醉腹股沟疝修补术，短期和长期发病率极低。当实习医生进行疝修补术时，建议使用大量稀释的利多卡因和布比卡因溶液。
