Raghunath Abirami J, Paul Subhankar, Raghunath Keddy Janakiraman
Department of General Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Hernia. 2025 Mar 17;29(1):121. doi: 10.1007/s10029-025-03295-x.
Inguinal hernia repair is one of the most common operations performed in General Surgery accounting for about 10-15% of all surgeries. Inguinal hernia repair can be done under local, spinal or general anaesthesia. Although specialized hernia centres routinely use local anaesthesia for uncomplicated open inguinal hernia repair, very few surgeons adopt this technique, and prefer performing surgery under spinal or general anaesthesia. We compared the short-term outcomes following open inguinal hernia mesh repair under local, spinal and general anaesthesia in our hospital.
(1) To compare the post-operative pain scores among the three groups. (2) To compare the duration of surgery in minutes, the duration of analgesia, analgesic requirement, the time of return to normal activity such as walking, the time of initiation of diet, and the time of voiding after the surgery. Also to compare any complications, such as urinary retention, need for catheterization, nausea and/or emesis, and the length of hospital stay. (3) To observe the impact on health-related quality of life according to EuroQol and patient satisfaction and acceptance of the type of anaesthesia for the procedure.
A single centre non-randomised, prospective, observational study was performed in 135 patients undergoing inguinal hernia repair under local (LA), spinal (SA) or general anaesthesia (GA), with 45 patients in each arm, over the span of one year. After approval from the Ethical Committee, and proper informed consent, patients above 18 years of age who were to undergo uncomplicated open inguinal hernioplasty were recruited for the study. Lichtensteins tension-free hernioplasty was performed in all cases. The duration of the procedure was calculated from the time of induction or infiltration of local or spinal anaesthesia, till the end of dressing, or extubation in case of general anaesthesia. The duration of analgesia was calculated from the end of the procedure to the feeling of first pain as recorded in the questionnaire. A standard postoperative protocol was employed to determine the pain scores for the first 7 days and also to compare the short-term outcomes i.e., duration of analgesia, return to normal activity, complications, post-operative nausea and emesis, analgesic requirement, urinary retention, length of hospital stay, health-related quality of life and patient satisfaction and acceptance were recorded according to standard proforma and EuroQol questionnaire. All the statistical analysis was carried out by SPSS version 16.0.
The mean pain scores were lower in the LA group as compared to SA and GA groups from POD-1 to POD-6 (p < 0.001). However, the values from the 7th post-operative days were similar in all three groups and statistically insignificant (p = 0.09). The outcomes such as duration of analgesia, return to activity such as walking, time of first meal and time of discharge from the hospital were all better in the LA group (p < 0.001). The results concerning nausea, vomiting, analgesic use and urinary retention all favour LA. No difference was found among the three groups concerning overall satisfaction and quality of life.
In a general surgical setting, we found that local anaesthesia is well tolerated and associated with significantly lower pain scores in the immediate post-operative period and also requires less analgesic use when compared with general and spinal anaesthesia. Patients in the LA group can resume basic activities such as walking, voiding, and initiating diet almost immediately after the procedure and there were no incidences of retention of urine, which was a significant advantage over the other two types of anaesthesia. Patients who were graded as ASA 4 and 5, who were unfit for general anaesthesia, were able to undergo the surgery under local anaesthesia with no postoperative complications. Moreover, the complications and risks of spinal and general anaesthesia are avoided without compromising the quality of surgery and its outcomes. The duration of the surgery as well as hospital stay is significantly less in patients undergoing surgery under local anaesthesia and most cases can be done as a daycare procedure, which is significantly advantageous, especially in low-income settings, with no difference in the health-related quality of life or patient satisfaction and acceptance.
腹股沟疝修补术是普通外科最常见的手术之一，约占所有手术的10% - 15%。腹股沟疝修补术可在局部、脊髓或全身麻醉下进行。尽管专业疝中心常规对无并发症的开放性腹股沟疝修补术使用局部麻醉，但很少有外科医生采用这种技术，而是更倾向于在脊髓或全身麻醉下进行手术。我们比较了我院在局部、脊髓和全身麻醉下进行开放性腹股沟疝补片修补术后的短期结局。
（1）比较三组术后疼痛评分。（2）比较手术时长（分钟）、镇痛时长、镇痛需求、恢复正常活动（如行走）的时间、开始进食时间以及术后排尿时间。还要比较任何并发症，如尿潴留、导尿需求、恶心和/或呕吐以及住院时间。（3）根据欧洲五维健康量表观察对健康相关生活质量的影响以及患者对手术麻醉类型的满意度和接受度。
在一年时间内，对135例接受局部麻醉（LA）、脊髓麻醉（SA）或全身麻醉（GA）下腹股沟疝修补术的患者进行了一项单中心非随机、前瞻性观察性研究，每组45例。经伦理委员会批准并获得适当的知情同意后，招募18岁以上拟行无并发症开放性腹股沟疝修补术的患者进行本研究。所有病例均采用利氏无张力疝修补术。手术时长从局部或脊髓麻醉诱导或浸润时间开始计算，直至包扎结束，全身麻醉则计算至拔管。镇痛时长从手术结束计算至问卷记录的首次疼痛感觉出现。采用标准术后方案确定前7天的疼痛评分，并比较短期结局，即镇痛时长、恢复正常活动情况、并发症、术后恶心和呕吐、镇痛需求、尿潴留、住院时间、健康相关生活质量以及患者满意度和接受度，根据标准表格和欧洲五维健康量表问卷进行记录。所有统计分析均使用SPSS 16.0版软件进行。
与SA组和GA组相比，LA组术后第1天至第6天的平均疼痛评分更低（p < 0.001）。然而，术后第7天三组的值相似，且无统计学意义（p = 0.09）。LA组在镇痛时长、恢复行走等活动、首次进食时间和出院时间等结局方面均更好（p < 0.001）。关于恶心、呕吐、镇痛药物使用和尿潴留的结果均支持LA组。三组在总体满意度和生活质量方面未发现差异。
在普通外科环境中，我们发现局部麻醉耐受性良好，与术后即刻显著更低的疼痛评分相关，并且与全身麻醉和脊髓麻醉相比，镇痛药物使用更少。LA组患者术后几乎可立即恢复行走、排尿和开始进食等基本活动，且无尿潴留发生，这是相对于其他两种麻醉方式的显著优势。被评为ASA 4级和5级、不适合全身麻醉的患者能够在局部麻醉下接受手术且无术后并发症。此外，避免了脊髓麻醉和全身麻醉的并发症和风险，同时不影响手术质量及其结局。局部麻醉下手术的患者手术时长和住院时间显著更短，大多数病例可作为日间手术进行，这具有显著优势，尤其是在低收入环境中，在健康相关生活质量或患者满意度和接受度方面无差异。
