Paravertebral blocks reduce the risk of postoperative urinary retention in inguinal hernia repair
Inguinal hernia repair and general anesthesia (GA) are known risk factors for urinary retention. Paravertebral blocks (PVBs) have been utilized to facilitate enhanced recovery after surgery. We evaluate the benefit of incorporating PVBs into our anesthetic technique in a large cohort of ambulatory patients undergoing inguinal hernia repair.
Records of 619 adults scheduled for ambulatory inguinal hernia repair between 2010 and 2015 were reviewed and categorized based on anesthetic and surgical approach [GA and open (GAO), GA and laparoscopic (GAL), PVB and open (PVBO), and GA/PVB and open (GA/PVBO)]. Patients were excluded for missing data, self-catheterization, chronic opioid tolerance, and additional surgical procedures coinciding with hernia repair. Risk factors associated with the primary outcome of urinary retention were examined using logistic regression.
PVBO (n = 136) had significantly lower odds than GAO of experiencing urinary retention (odds ratio 0.16; 95% CI 0.05–0.51); overall (P < .01), with 4.4% (n = 6) of the patients in the PVBO group having urinary retention versus 22.6% (n = 7) with GAO. Expressed as intravenous morphine equivalences, the PVBO group had the lowest median opioid use (5 mg), followed by GA, PVB, and open (7.5 mg); GAO 25 mg; and GAL 25 mg. Also, 30% (n = 41) of the PVBO group required no opioid analgesia in the postanesthesia care unit.
PVBs as the primary anesthetic or an adjunct to GA is the preferred anesthetic technique for open inguinal hernia repair as it facilitates enhanced recovery after surgery by decreasing risk of urinary retention, opioid requirements, and length of stay.
KeywordsDecreased length of stay Inguinal hernia repair Paravertebral blocks Postoperative urinary retention Regional anesthesia
EB: research design, data collection, analysis and interpretation of data, drafting of the manuscript, and corresponding author. JZL: research design, data collection, analysis and interpretation of data, and drafting of the manuscript. SB: research design, analysis and interpretation of data, and editing of the manuscript. RDF: statistical analysis, interpretation of data, generation of figures and tables, and editing of the manuscript. SP: data collection, analysis and interpretation of data, and editing of the manuscript. AR: research design, data collection, and editing of the manuscript. SP: data collection, and editing of the manuscript. RAG: research design, drafting and editing of the manuscript.
Mayo Clinic Comprehensive Research Team.
Compliance with ethical standards
Conflict of interest
EB declares no conflict of interest. JL declares no conflict of interest. SB declares no conflict of interest. RDF declares no conflict of interest. SHP declares no conflict of interest. AR declares no conflict of interest. SP declares no conflict of interest. RAG declares no conflict of interest.
Ethical approval was obtained from institutional review board (no. 15-008258).
Human and animal rights
This article does not contain any studies with human participants and animals performed by any of the authors.
For this retrospective review, formal consent is not required.
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