World Journal of Surgery

, Volume 29, Issue 8, pp 1058–1061 | Cite as

Groin Hernia Repair: Anesthesia

Article

Abstract

The choice of anesthesia for groin hernia repair is between general, regional (epidural or spinal), and local anesthesia. Existing data from large consecutive patient series and randomized studies have shown local anesthesia to be the method of choice because it can be performed by the surgeon, does not necessarily require an attending anesthesiologist, translates into the shortest recovery (bypassing the postanesthesia care unit), has the lowest cost, and has the lowest postoperative morbidity regarding risk of urinary retention. Spinal anesthesia has no documented benefits for this small operation and should be avoided owing to the risk of rare neurologic side effects and the high risk of urinary retention. General anesthesia with short-acting agents may be a valid alternative when combined with local infiltration anesthesia, although an anesthesiologist is required. Despite sufficient scientific data to support the choice of anesthesia, large epidemiologic and nationwide information from databases show an undesirable high (about 10–20%) use of spinal anesthesia and low (about 10%) use of local infiltration anesthesia. Surgeons and anesthesiologists should therefore adjust their anesthesia practices to fit the available scientific evidence.

Notes

Acknowledgment

This study was supported by a grant from The Lundbeck Foundation and Danish Research Council 22-01-0160.

References

  1. 1.
    Kingsnorth A, LeBlanc K. 2003. Hernias: inguinal, incisional Lancet. 362:1561–1571CrossRefPubMedGoogle Scholar
  2. 2.
    Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 2005 (in press)Google Scholar
  3. 3.
    Hair A, Duffy K, Mclean J, et al. 2000. Groin hernia repair in Scotland Br. J. Surg. 87:1722–1726CrossRefPubMedGoogle Scholar
  4. 4.
    Nordin P, Haapaniemi S, van Der Linden W, et al. 2004. Choice of anesthesja and risk of reoperation for recurrence in groin hernia repair Ann. Surg. 240:187–192CrossRefPubMedGoogle Scholar
  5. 5.
    Bay-Nielsen M, Kehlet H, Strand L, et al. 2001. Quality assessment of 26,304 herniorrhaphies in Denmark; a nationwide questionnaire study Lancet, 358:1124–1128CrossRefPubMedGoogle Scholar
  6. 6.
    Kehlet H, Bay-Nielsen M. Anaesthetic practice for groin hernia repair: a nationwide study in Denmark 1998–2003. Acta Anaesthesiol Scand 2005 49: 143–146Google Scholar
  7. 7.
    Kark AE, Kurzer MN, Belsham PA. 1998. 3175 Primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia J. Am. Coll. Surg. 186:447–455CrossRefPubMedGoogle Scholar
  8. 8.
    Amid PK, Schulman AG, Lichtenstein IL. 1994. Local anesthesia for inguinal hernia repair: step-by-step procedure Ann. Surg. 220:735–737PubMedGoogle Scholar
  9. 9.
    Glassow F. 1976. Short-stay surgery (Shouldice technique for repair of inguinal hernia) Ann. R. Coll. Surg. Engl. 58:133–139PubMedGoogle Scholar
  10. 10.
    Callesen T, Bech K, Kehlet H. 2001. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia Anesth. Analg. 93:1373–1376CrossRefPubMedGoogle Scholar
  11. 11.
    Kingsnorth AN, Bowley DMG, Porter C. 2003. A prospective study of 1000 hernias: results of the Plymouth Hernia Service Ann. R. Coll. Surg. Engl. 85:18–22CrossRefPubMedGoogle Scholar
  12. 12.
    Robbins AW, Rutkow IM. 1998. Mesh plug repair and groin hernia surgery Surg. Clin. North Am. 78:1007–1023CrossRefPubMedGoogle Scholar
  13. 13.
    Kehlet H, White PF. 2001. Optimizing anesthesia for inguinal hemiorrhaphy: general, regional or local anesthesia? Anesth. Analg. 93:1367–1369PubMedGoogle Scholar
  14. 14.
    Heidemann Andersen F, Nielsen K, et al. combined ileoinguinal blockade and infiltration anaesthesia for inguinal hemiorrhaphy. Br. J. Anaesth. 2005 94: 520–523Google Scholar
  15. 15.
    Callesen T, Bech K, Kehlet H. 2001. Feasibility of local infiltration anaesthesia for recurrent groin hernia repair Eur. J. Surg. 167:851–854CrossRefPubMedGoogle Scholar
  16. 16.
    Jensen P, Mikkelsen T, Kehlet H. 2002. Postherniorrhaphy urinary retention: effect of local, regional and general anesthesia; a review Reg. Anesth. Pain Med. 27:612–617CrossRefPubMedGoogle Scholar
  17. 17.
    Nordin P, Zetterström H, Gunnarsson U, et al. 2003. Local, regional or general anaesthesia in groin hernia repair: multicentre randomised trial Lancet 362:853–858CrossRefPubMedGoogle Scholar
  18. 18.
    Özgün H, Kurt MN, Kurt I, et al. 2002. Comparison of local, spinal and general anaesthesia for inguinal hemiorrhaphy Eur. J. Surg. 168:455–459CrossRefPubMedGoogle Scholar
  19. 19.
    Gönüllü NN, Cubukcu A, Alponat A. 2002. Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial Hernia 6:29–32CrossRefPubMedGoogle Scholar
  20. 20.
    Aasbø V, Thuen A, Ræder J. 2002. Improved long-lasting postoperative analgesia, recovery function and patient satisfaction after inguinal hernia repair with inguinal field block compared with general anesthesia Acta Anaesthesiol. Scand. 46:647–678CrossRefGoogle Scholar
  21. 21.
    Song D, Greilich B, White PF, et al. 2000. Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphy Anesth. Analg. 91:876–881CrossRefPubMedGoogle Scholar
  22. 22.
    Nordin P, Hernell H, Unosson M, et al. 2004. Type of anaesthesia and patient acceptance in groin hernia repair: a multicentre randomised trial Hernia 8:220–225CrossRefPubMedGoogle Scholar
  23. 23.
    O’Dwyer P, Serpell MG, Millar K, et al. 2003. Local or general anesthesia for open hernia repair: a randomised trial Ann. Surg. 237:574–579CrossRefPubMedGoogle Scholar
  24. 24.
    Kendell J, Wildsmith JAW, Gray IG. 2000. Costing anaesthetic practice; an economic comparison of regional and general anaesthesia for varicose vein and inguinal hernia surgery Anaesthesia 55:1106–1126CrossRefPubMedGoogle Scholar
  25. 25.
    Callesen T, Bech K, Kehlet H. 1998. The feasibility, safety and cost of infiltration anaesthesia for hernia repair Anaesthesia 53:31–35CrossRefPubMedGoogle Scholar
  26. 26.
    Sørensen LT, Friis E, Jørgensen T, et al. 2002. Smoking is a risk factor for recurrence of groin hernia World J. Surg. 26:397–400CrossRefPubMedGoogle Scholar
  27. 27.
    Kingsnorth AN, Britton BJ, Morris BJ. 1981. Recurrent inguinal hernia after local anaesthetic repair Br. J. Surg. 68:273–275PubMedGoogle Scholar
  28. 28.
    Møiniche S, Kehlet H, Dahl JB. 2002. A qualitative and quantitative systematic review of pre-emptive analgesia for postoperative pain relief: the role of timing of analgesia Anesthesiology 96:725–741CrossRefPubMedGoogle Scholar
  29. 29.
    Klein SM, Pietrobon R, Nielsen KC, et al. 2002. Paravertebral somatic nerve block compared with peripheral nerve blocks for outpatient inguinal herniorrhaphy Reg. Anesth. Pain Med. 27:476–480CrossRefPubMedGoogle Scholar
  30. 30.
    Moen V, Dahlgren N, Irestedt L. 2004. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999 Anesthesiology 101:950–959CrossRefPubMedGoogle Scholar
  31. 31.
    Mulroy MF, Burgess FW, Emanuelsson BM. 1999. Ropivacaine 0.25% and 0.5%, but not 0.125% provide effective wound infiltration analgesia after outpatient hernia repair, but with sustained plasma drug levels Reg. Anesth. Pain Med. 24:136–141CrossRefPubMedGoogle Scholar
  32. 32.
    Kehlet H, Dahl JB. 2003. Spinal anaesthesia for inguinal hernia repair? Acta Anaesthesiol Scand. 47:1–2Google Scholar

Copyright information

© Société Internationale de Chirurgie 2005

Authors and Affiliations

  1. 1.Section of Surgical Pathophysiology 4074The Juliane Marie CentreRigshospitaletDenmark

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