Page 54 - International guidelines for groin hernia management

Hernia

Introduction performing IH repair under local anesthesia. 648 Beginners,
Local anesthesia has several advantages to regional and defined as those who have repaired less than six hernias
general anesthesia. However, data from hernia registries under local anesthesia, had a significantly higher recur-
suggest that the hernia reoperation rate may be higher after rence rate. The study authors concluded that beginners
local anesthesia when compared with general or regional should be closely supervised during their first six
anesthesia. 50 Reoperation rates after hernia repair by pri- operations.
vate surgeons using local anesthesia are lower than those These few studies suggest that in the case of IH repairs
seen following primary IH repair in general hospitals. A done under local anesthesia, experience in local anesthesia
higher level of expertise in local anesthesia administration administration influences recurrence/reoperation rates.
seems to be associated with a lower reoperation risk. Does Trainees can safely perform these operations, but super-
this also apply to physicians in the midst of learning curves vision by a surgeon with the requisite experience is nec-
like surgical residents/registrars? essary to achieve optimal outcomes.

Evidence in literature Chapter 14
Five observational studies have examined complication
rates after open IH repair under local anesthesia by
trainees. 644–648 We excluded one of these articles from Early postoperative pain prevention
analysis because it only investigated results in patients and management
operated on by fully trained surgeons who wanted to learn
local anesthetic administration. 647 An Italian language P. Nordin and A. R. Wijsmuller
644
article. was also excluded from analysis, leaving three
English-language publications for review. 645, 646, 648 Two Introduction
studies reported no complication rate differences including Several approaches to postoperative pain management
no difference in recurrence rate after 10 years of follow-up have been studied including various medical treatments
after trainee-performed operations versus consultant-per- and interventions like the use of local anesthetics. This
formed operations despite use of higher local anesthetic chapter reviews the literature on preoperative, periopera-
volumes by trainees. 645, 646 One study investigated the tive, and postoperative interventions designed to treat pain
influence of experience on recurrence rates in 24 surgeons after open groin hernia repair.

Key questions

KQ14.a Do preoperative or perioperative local anesthetic
methods affect patients’ pain experiences after open groin
hernia repair?
KQ14.b Which is the most effective oral analgesic pain
management regimen after groin hernia repair?

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