Department of General Surgery, West Suffolk Hospital, Bury St. Edmunds, Suffolk, IP33 2QZ, UK.
Hernia. 2013 Aug;17(4):499-504. doi: 10.1007/s10029-013-1085-8. Epub 2013 Mar 31.
Paraumbilical hernia (PUH) is a common condition that usually requires surgical repair. However, there is a dearth of literature on this surgery performed under local anaesthesia (LA) without the use of sedation. The aims of this study were to assess peri-operative pain and patient satisfaction in patients undergoing PUH repair using LA without sedation.
All patients having PUH repair under a single consultant between January 2010 and December 2011 were eligible to participate. If eligible for both, patients chose either general anaesthetic (GA) or LA repair. If only eligible for either LA or GA, they were offered this anaesthetic modality. Visual analogue scales were used to report peri-operative pain (10 point score) and satisfaction (%). Results were compared by grade of surgeon (higher surgical trainee (HST) versus consultant).
A total of 63 patients underwent PUH repair (31 GA; 32 LA). Of them, only 28/32 of LA repair patients agreed to participate. LA and GA patients had equivalent age and sex distribution. LA patients had a lower body mass index (BMI) than GA [27.1 (3.7) versus 30.3 (5.1), p = 0.007]. The median length of LA procedure was 24 (17.5-30) minutes. The median LA solution infiltrated was 25 (20-32) ml. Peri-operative pain scores were low [1.1 (0.3-2.9) %] and patient satisfaction was high [96 (91-99) %]. There were no differences in pain, patient satisfaction, duration of procedure and amount of LA infiltrated with increasing BMI. Comparing HST to consultant, the former took longer [30 (25-36) versus 20 (16-24) minutes, p = 0.0007], infiltrated more LA [34.5 (26-47) versus 20 (19-25.5) ml, p = 0.0039], and patients reported more pain [2.75 (1.0-4.95) versus 0.4 (0.2-1.7) %, p = 0.029], but overall satisfaction was equivalent [95.5 (89-99.25) versus 96.3 (92.25-99) %, p = 0.684].
Open mesh PUH repair using LA without sedation is associated with low peri-operative pain and very high satisfaction when either a higher surgical trainee or a consultant grade is operating.
脐旁疝（PUH）是一种常见病症，通常需要手术修复。然而，目前关于在不使用镇静剂的情况下局部麻醉（LA）下进行这种手术的文献很少。本研究旨在评估在 LA 下不使用镇静剂进行 PUH 修复的围手术期疼痛和患者满意度。
2010 年 1 月至 2011 年 12 月期间，所有在一名顾问医生下接受 PUH 修复的患者均有资格参与。如果符合 LA 和 GA 两种麻醉方式的条件，患者可以选择 GA 或 LA 修复。如果仅符合 LA 或 GA 条件，则提供这种麻醉方式。使用视觉模拟评分（10 分制）报告围手术期疼痛（10 分）和满意度（%）。结果按手术医生级别（高年住院医师（HST）与顾问医生）进行比较。
共有 63 例患者接受了 PUH 修复（31 例 GA；32 例 LA）。其中，仅 28/32 例 LA 修复患者同意参与。LA 和 GA 患者的年龄和性别分布相当。LA 患者的体重指数（BMI）低于 GA [27.1（3.7）比 30.3（5.1），p=0.007]。LA 手术的中位数时间为 24 分钟（17.5-30 分钟）。LA 溶液的中位数注入量为 25 毫升（20-32 毫升）。围手术期疼痛评分较低[1.1（0.3-2.9）%]，患者满意度较高[96（91-99）%]。BMI 增加与疼痛、患者满意度、手术持续时间和 LA 注入量均无差异。与顾问医生相比，HST 组手术时间更长[30 分钟（25-36 分钟）比 20 分钟（16-24 分钟），p=0.0007]，LA 注入量更多[34.5 毫升（26-47 毫升）比 20 毫升（19-25.5 毫升），p=0.0039]，患者报告的疼痛更严重[2.75（1.0-4.95）比 0.4（0.2-1.7）%，p=0.029]，但总体满意度相当[95.5（89-99.25）比 96.3（92.25-99）%，p=0.684]。
当手术医生为高年住院医师或顾问医生时，使用 LA 不使用镇静剂进行开放式网片修补 PUH 与低围手术期疼痛和非常高的满意度相关。
