COMPARISON OF EFFICACY OF SPINAL ANAESTHESIA AND SUB-FASCIAL LOCAL ANAESTHETIC INGUINAL FIELD BLOCK FOR OPEN INGUINAL HERNIA REPAIR-A SINGLE INSTITUTIONAL EXPERIENCE
Abstract
Background: The use of local anaesthetic for open inguinal hernia surgery has long been restricted to specialist centres. This study aimed to compare the efficacy of spinal anaesthesia and sub-fascial local anaesthetic (LA) for performing open hernia repair and at the same time provide better post op pain relief and early mobilization. Methods: In this randomized clinical trial, 62 male patients aged 16–72 were randomly allocated to two groups. Group A received mixture of 20ml 0.5% bupivacain,20ml 2% lignocaine with adrenaline, 20ml normal saline (N/S), 3 ml NaHCO3 sub-fascially for Local anaesthetic (LA) inguinal field block, while Group B received Spinal Anaesthesia (SA) with 0.5%Bupivacaine. Comparison was made in terms of Visual Analogue Score (VAS) recorded intra-operatively at 0 and 30 minutes and post operatively at 2, 4 and 12 hours at rest and on movement. Need for rescue analgesia and total analgesic consumption in both groups were calculated. Interval to pain free ambulation as well as procedural and anaesthesia related complications were compared. Results: Mean VAS in the intraoperative period were significantly high in Group A (p-value 0.011) at the start of operation and at 30 minutes (p-value <0.001). However, it did not correlate with patient satisfaction as 90% of patients in Group A successfully underwent the procedure without need for supplemental analgesia. VAS scores at rest and on movement/cough were comparable in the post op period at 2, 4 and 12 hours in both groups. Interval to pain free ambulation was significantly low in Group A (p-value 0.0012). Conclusion: Sub facial LA inguinal field block provides effective anaesthesia with optimum post op analgesia, prompt recovery and fewer systemic side effects compared to SA and can safely be used for routine open inguinal hernia surgery.Keywords: Spinal Anaesthesia, Sub-Fascial local anaesthetic inguinal field block, open inguinal hernia repair, efficacyReferences
Anand A, Sinha PA, Kittappa K, Mulchandani MH, Debrah S, Brookstein R. Review of Inguinal Hernia Repairs by Various Surgical Techniques in a District General Hospital in the UK. Indian J Surg 2011;73(1):13–8.
Langesæter E, Dyer RA. Maternal haemodynamic changes during spinal anaesthesia for caesarean section. Curr Opin Anaesthesiol 2011;24(3):242–8
Kaban OG, Yazicioglu D, Akkaya T, Sayin MM, Seker D, Gumus H. Spinal anaesthesia with hyperbaric prilocaine in day-case perianal surgery: randomized controlled trial. Scientific World Journal 2014;2014:608372.
Santos Gde C, Braga GM, Queiroz FL, Navarro TP, Gomez RS. Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study. Rev Assoc Med Bras 2011;57(5):545–9.
Song Y, Han B, Lei W, Kou Y, Liu Y, Gong Y, Ma D. Low concentrations of lidocaine for inguinal hernia repair under local infiltration anaesthesia. J Int Med Res 2013;41(2):371–7.
Ball EL, Sanjay P, Woodward A. Comparison of buffered and un-buffered local anaesthesia for inguinal hernia repair: a prospective study. Hernia 2006;10(2):175–8.
Myers E, Browne KM, Kavanagh DO, Hurley M. Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes. World J Surg 2010;34(12):3059–64
Sajid MS, Craciunas L, Singh KK, Sains P, Baig MK. Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials. Gastroenterol Rep (Oxf) 2013;1(2):127–37.
Demirci A, Efe EM, Turker G, Gurbet A, Kaya FN, Anil A, Cimen I Iliohypogastric/ilioinguonal nerve block in inguinal hernia repair for post op pain management;a comparison of anatomical landmark and ultrasound guided technique. Revista brasileira de anestesiologia 2014;64(5):350–6
Kingsnorth A. Local Anesthetic Hernia Repair: Gold Standard for One and All. World J Surg 2009;33(1):142–4.
Nordin P, Zetterström H, Gunnarsson U, Nilsson E. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet 2003;362(9387):853–8.
Dabić D1, Perunicić V, Marić B. "One step procedure" local anaesthesia for inguinal hernia repair in ambulatory surgery conditions--district general hospital experience. Acta Chir Iugosl 2012;59(1):87–93.
Amato B, Compagna R, Fappiano F, Rossi R, Bianco T, Danzi M, et al. Massa S. Day-surgery inguinal hernia repair in the elderly: single centre experience. BMC Surg 2013;13 Suppl 2:S28.
Sanjay P, Woodward A.Inguinal Hernia Repair: Local or General Anaesthesia? Ann R Coll Surg Engl 2007;89(5):497–503.
Joshi GP, Rawal N, Kehlet H; PROSPECT collaboration, Bonnet F, Camu F, Fischer HB, Neugebauer EA, Schug SA, Simanski CJ. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg 2012;99
Niaz K, Iqbal J, Khan MI, Sarfraz M. Comparison of Inguinal Herniorrhaphy under Local and Spinal Anaesthesia. (correct plz)2):168–85.
Goyal P, Sharma SK, Jaswal KS, Goyal S .Comparison of inguinal hernia repair under local anesthesia versus spinal anesthesia. IOSR J Dent Med Sci 2014;13(1):54–9
Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F, Vinet E, et al. Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth 2011;106(3):380–6
Bærentzen F, Maschmann C, Jensen K, Belhage B, Hensler M, Børglum J. Ultrasound-guided nerve block for inguinal hernia repair: a randomized, controlled, double-blind study. Reg Anesth Pain Med 2012;37(5):502–7.
de Sá Ribeiro FA, Padron F, Castro TD, Torres Filho LC, Fernandes Bde A. Inguinal hernia repair with local anesthesia in the outpatient. Rev Col Bras Cir 2010;37(6):397–402.
Dhumale R, Tisdale J, Barwell N. Over a thousand ambulatory hernia repairs in a primary care setting. Ann R Coll Surg Engl 2010;92(2):127–30.
Saia M, Mantoan D, Buja A, Bertoncello C, Baldovin T, Zanardo C, et al. Increased rate of day surgery use for inguinal and femoral hernia repair in a decade of hospital admissions in the Veneto Region (north-east Italy): a record linkage study. BMC Health Serv Res. 2013;13:349
Cheong KX, Lo HY, Neo JX, Appasamy V, Chiu MT. Inguinal hernia repair: are the results from a general hospital comparable to those from dedicated hernia centres? Singapore Med J. 2014;55(4):191–7.
Hammond CB. Care of patients undergoing day case inguinal hernia repair. Nurs Stand 2014;28(31):53–9.
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