Division of General Surgery, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
Division of Anaesthesia, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
Hernia. 2019 Jun;23(3):561-567. doi: 10.1007/s10029-019-01922-y. Epub 2019 Mar 7.
Conscious sedation is regularly used in ambulatory surgery to improve patient outcomes, in particular patient satisfaction. We hypothesized that the addition of conscious sedation would provide greater patient satisfaction with inguinal hernioplasty compared to local anesthesia alone.
This trial was a single-centre, randomized, placebo-controlled, double-blinded trial where patients undergoing inguinal hernioplasty using local anaesthesia were randomized to receive local anaesthesia alone versus local anaesthesia and conscious sedation. The primary outcome of patient satisfaction was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS). The study was powered to detect a significant difference in ISAS scores between groups. Comparisons were made using T test and Chi square tests. A p value of less than 0.05 was considered significant.
There were 149 patients randomized: 78 to the local anesthesia (LA) group and 71 to the local anaesthesia and conscious sedation (LACS) group. For the primary outcome measure of patient satisfaction, the mean ISAS score was significantly greater in the LACS group (p = 0.009). The experience of pain and pain severity was greater in the LA group (p = 0.016; p = 0.0162 respectively). No statistically significant difference was found between groups with respect to operative time, time to discharge or postoperative complications.
The use of conscious sedation with local anesthesia for inguinal hernioplasty is safe, results in less pain experience and severity and is associated with better patient satisfaction. The use of conscious sedation does not delay patient discharge.
在门诊手术中，常规使用镇静以改善患者的预后，尤其是患者满意度。我们假设与单纯局部麻醉相比，镇静辅助局部麻醉将提高腹股沟疝修补术患者的满意度。
这是一项单中心、随机、安慰剂对照、双盲试验，接受局部麻醉的腹股沟疝修补术患者被随机分为接受单纯局部麻醉与接受局部麻醉和镇静辅助麻醉。使用爱荷华州麻醉满意度量表（ISAS）评估患者满意度作为主要结局。该研究旨在检测组间 ISAS 评分的显著差异。采用 T 检验和卡方检验进行比较。p 值小于 0.05 被认为具有统计学意义。
共有 149 名患者随机分组：78 名患者接受局部麻醉（LA）组，71 名患者接受局部麻醉和镇静辅助麻醉（LACS）组。在患者满意度的主要测量指标中，LACS 组的 ISAS 评分显著更高（p=0.009）。LA 组的疼痛体验和疼痛严重程度更大（p=0.016；p=0.0162）。两组在手术时间、出院时间或术后并发症方面无统计学差异。
局部麻醉联合镇静辅助用于腹股沟疝修补术是安全的，可减少疼痛体验和严重程度，并与患者满意度提高相关。使用镇静辅助不会延迟患者出院。
