Page 51 - International guidelines for groin hernia management

Hernia

In a high-risk environment (defined by a [ 5% inci- performed via epidural, spinal and paravertebral routes.
dence of wound infection) there is a significant benefit of However, a discussion of paravertebral anesthesia is not
antibiotic prophylaxis. Therefore, in institutions with high included in this section since limited data are available on
wound infection rates, antibiotic prophylaxis is highly this technique.
recommended. Furthermore, in these institutions the gen- The ideal anesthetic technique: provides good periop-
eral risk factors influencing wound infections should be erative and postoperative analgesia, produces optimal
checked (like hygiene routines, shaving on the day before operating conditions by immobility, is associated with few
608
surgery and seroma aspiration, etc.). complications, facilitates early patient discharge, and is
It is a fact that in some countries prophylactic antibiotics cost effective. The EHS guidelines on IH treatment rec-
are a required indicator and considered a quality measure ommends that local anesthesia be considered for all adult
by Centers for Medicare and Medicaid services. Her- patients with primary reducible unilateral IHs.
niaSurge recommends these countries to reconsider this
and adjust requirements to evidence-based guidelines.

Chapter 13 Evidence in literature
We identified one meta-analysis and five reviews com-
609–614
paring local to general anesthesia. Of 17 randomized
Anesthesia trials found, 615–631 the most recent are included in the
reviews. 616, 620, 629 SIGN analysis of the 2009 meta-anal-
A. R. Wijsmuller and P. Nordin ysis revealed methodological shortcomings. 610 One short-
coming was the performance of a meta-analysis on urinary
Key question retention despite heterogeneity between studies. In addi-
tion, urinary retention data from the largest RCT compar-
KQ13.a Does local anesthesia influence outcomes after ing general to local anesthesia were omitted. These omitted
open repair of reducible inguinal hernia when compared figures demonstrate a lower incidence of urinary retention
with general or regional anesthesia? after local anesthesia when compared with general anes-
thesia. 629 A more recent 2012 review did not perform a
Introduction meta-analysis because of included study design varia-
General, regional and local anesthetic techniques are used tion 611, 614 and found a lower incidence of urinary retention
to facilitate open IH surgery. Regional anesthesia can be following local anesthesia. 614

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