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Hernia

pp 1–9 | Cite as

Paravertebral blocks reduce the risk of postoperative urinary retention in inguinal hernia repair

  • E. Bojaxhi
  • J. Lee
  • S. Bowers
  • R. D. Frank
  • S. H. Pak
  • A. Rosales
  • S. Padron
  • R. A. Greengrass
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Decreased length of stay Inguinal hernia repair Paravertebral blocks Postoperative urinary retention Regional anesthesia 

Notes

Author contributions

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.

Funding

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

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.

Informed consent

For this retrospective review, formal consent is not required.

References

  1. 1.
    Law LS, Tan M, Bai Y, Miller TE, Li YJ, Gan TJ (2015) Paravertebral block for inguinal herniorrhaphy: a systematic review and meta-analysis of randomized controlled trials. Anesth Analg 121:556–569CrossRefPubMedGoogle Scholar
  2. 2.
    Ozgun H, Kurt MN, Kurt I, Cevikel MH (2002) Comparison of local, spinal, and general anaesthesia for inguinal herniorrhaphy. Eur J Surg 168:455–459CrossRefPubMedGoogle Scholar
  3. 3.
    Tan M, Law LS, Gan TJ (2015) Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Can J Anaesth 62:203–218CrossRefPubMedGoogle Scholar
  4. 4.
    Hadzic A, Kerimoglu B, Loreio D, Karaca PE, Claudio RE, Yufa M, Wedderburn R, Santos AC, Thys DM (2006) Paravertebral blocks provide superior same-day recovery over general anesthesia for patients undergoing inguinal hernia repair. Anesth Analg 102:1076–1081CrossRefPubMedGoogle Scholar
  5. 5.
    Eason MJ, Wyatt R (1979) Paravertebral thoracic block-a reappraisal. Anaesthesia 34:638–642CrossRefPubMedGoogle Scholar
  6. 6.
    Amid PK, Shulman AG, Lichtenstein IL (1994) A critical comparison of laparoscopic hernia repair with Lichtenstein tension-free hernioplasty. Med J Aust 161:239–241PubMedGoogle Scholar
  7. 7.
    Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110:1139–1157CrossRefPubMedGoogle Scholar
  8. 8.
    Naja ZM, Raf M, El-Rajab M, Daoud N, Ziade FM, Al-Tannir MA, Lonnqvist PA (2006) A comparison of nerve stimulator guided paravertebral block and ilio-inguinal nerve block for analgesia after inguinal herniorrhaphy in children. Anaesthesia 61:1064–1068CrossRefPubMedGoogle Scholar
  9. 9.
    Klein SM, Pietrobon R, Nielsen KC, Steele SM, Warner DS, Moylan JA, Eubanks WS, Greengrass RA (2002) Paravertebral somatic nerve block compared with peripheral nerve blocks for outpatient inguinal herniorrhaphy. Reg Anesth Pain Med 27:476–480CrossRefPubMedGoogle Scholar
  10. 10.
    Kaya C, Koksal E, Ustun YB, Yilmar MZ, Torun AC, Ozkan F (2014) Comparative effects of transversus Abdominis plane and paravertebral block on postoperative pain in inguinal hernia surgery. Acta Medica Mediterr 30:341–346Google Scholar
  11. 11.
    Kuipers PW, Kamphuis ET, van Venrooij GE, van Roy JP, Ionescu TI, Knape JT, Kalkman CJ (2004) Intrathecal opioids and lower urinary tract function: a urodynamic evaluation. Anesthesiology 100:1497–1503CrossRefPubMedGoogle Scholar
  12. 12.
    Dray A, Metsch R (1984) Opioids and central inhibition of urinary bladder motility. Eur J Pharmacol 98:155–156CrossRefPubMedGoogle Scholar
  13. 13.
    Matsuura S, Downie JW (2000) Effect of anesthetics on reflex micturition in the chronic cannula-implanted rat. Neurourol Urodyn 19:87–99CrossRefPubMedGoogle Scholar
  14. 14.
    Kamphuis ET, Ionescu TI, Kuipers PW, de Gier J, van Venrooij GE, Boon TA (1998) Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men. Anesthesiology 88:310–316CrossRefPubMedGoogle Scholar
  15. 15.
    Axelsson K, Mollefors K, Olsson JO, Lingardh G, Widman B (1985) Bladder function in spinal anaesthesia. Acta Anaesthesiol Scand 29:315–321CrossRefPubMedGoogle Scholar
  16. 16.
    Sanjay P, Woodward A (2007) Inguinal hernia repair: local or general anaesthesia? Ann R Coll Surg Engl 89:497–503CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Callesen T, Bech K, Nielsen R, Andersen J, Hesselfeldt P, Roikjaer O, Kehlet H (1998) Pain after groin hernia repair. Br J Surg 85:1412–1414CrossRefPubMedGoogle Scholar
  18. 18.
    McCormack K, Scott NW, Go PM, Ross S, Grant AM, EU Hernia Trialists Collaboration (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785Google Scholar
  19. 19.
    Tammela T, Kontturi M, Lukkarinen O (1986) Postoperative urinary retention. I. Incidence and predisposing factors. Scand J Urol Nephrol 20:197–201CrossRefPubMedGoogle Scholar
  20. 20.
    Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, Desmonts JM (2005) Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg 101:592–596 (table of contents) CrossRefPubMedGoogle Scholar
  21. 21.
    Petersen MS, Collins DN, Selakovich WG, Finkbeiner AE (1991) Postoperative urinary retention associated with total hip and total knee arthroplasties. Clin Orthop Relat Res 269:102–108Google Scholar
  22. 22.
    Gerstenberg TC, Nielsen ML, Clausen S, Blaabjerg J, Lindenberg J (1980) Bladder function after abdominoperineal resection of the rectum for anorectal cancer. Urodynamic investigation before and after operative in a consecutive series. Ann Surg 191:81–86CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Weltz CR, Mein SM, Arbo JE, Greengrass RA (2003) Paravertebral block anesthesia for inguinal hernia repair. World J Surg 27:425–429CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Perioperative MedicineMayo ClinicJacksonvilleUSA
  2. 2.Department of SurgeryMayo ClinicJacksonvilleUSA
  3. 3.Division of Biomedical Statistics and InformaticsMayo ClinicRochesterUSA
  4. 4.Department of AnesthesiologyGood Samaritan HospitalMount VernonUSA
  5. 5.Department of AnesthesiologySt. Vincent’s HospitalJacksonvilleUSA
  6. 6.Department of SurgeryCleveland Clinic FloridaWestonUSA
  7. 7.Nova Southeastern University School of MedicineFort LauderdaleUSA

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