Page 53 - International guidelines for groin hernia management

Hernia

Evidence in literature regional anesthesia patients were significantly more likely
Five reviews 611–614, 639 and nine RCTs 620, 624, 629, 631, to require bladder catheterization for urinary retention.
635, 640–642 639
comparing general to regional anesthesia were Another recent systematic review excluded this
629
identified. The majority of these RCTs compared general, RCT as well because many patients underwent two
regional and local anesthesia. 620, 624, 629, 635, 642 Two of different anesthetic modalities. This systematic review also
these five RCTs were excluded from this analysis since reported a lower incidence of urinary retention in the
they mainly focused on pulmonary function assess- general anesthesia group. Less early postoperative pain was
ment. 624, 635 A 2002 review, based mostly on cohort seen in the regional anesthesia group. There were no dif-
studies, and including 26,653 patients undergoing hernia ferences between groups in the incidence of other
repair with either general or spinal anesthesia, did not complications.
report a statistically significant inter-group difference (3 An analysis done on 29,033 elective groin hernia repairs
versus 2.4%, respectively). 611 from the Danish Hernia Database found a higher incidence
A 2012 review of four randomized trials with 180 of medical complications in patients aged 65 years and
patients reported inconclusive results on early postopera- older after regional anesthesia (1.17%) compared with
tive pain. 614 The review indicated that there might be a general anesthesia (0.59%). 643 Complications included
reduction in analgesic need in the early postoperative myocardial infarction, pneumonia and venous
period following spinal anesthesia. The effect on postop- thromboembolisms.
erative nausea was similarly inconclusive with one 620 of
two RCTs reporting a significant difference favoring spinal Discussion, consensus, clarification of grading
anesthesia while the other found no difference. 620, 641 Some high-quality medical evidence is available to address
The same 2012 review reported faster patient discharge KQ13.b. Several RCTs support the statements and rec-
after general anesthesia. No inter-group difference is ommendations above. Barring the questionable value of a
reported in patient satisfaction scores. The incidence of statistically significant but clinically negligible faster
urinary retention is not reported in the review. patient discharge, no clear benefits of general over spinal
The largest RCT 629 comparing local, general and anesthesia have been reported except in those 65 and older.
regional anesthesia was not included in the section of the Urinary retention might be more frequent following
2012 review comparing general to regional anesthesia. The regional anesthesia. A moderate level of evidence supports
excluded RCT randomized 397 patients to either regional the recommendation above.
or general anesthesia. The majority of patients (62%) in
both groups received local anesthetic infiltration as well. Key question
Pain, nausea, early postoperative complications, hospital
length of stay, patient satisfaction and costs were not sig- KQ13.c Can surgical residents/registrars safely perform
nificantly different between groups. 615, 629, 632 However, open inguinal hernia repair using local anesthesia?

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