Improving patient outcomes with inguinal hernioplasty—local anaesthesia versus local anaesthesia and conscious sedation: a randomized controlled trial
Conscious sedation is regularly used in ambulatory surgery to improve patient outcomes, in particular patient satisfaction. We hypothesized that the addition of conscious sedation would provide greater patient satisfaction with inguinal hernioplasty compared to local anesthesia alone.
This trial was a single-centre, randomized, placebo-controlled, double-blinded trial where patients undergoing inguinal hernioplasty using local anaesthesia were randomized to receive local anaesthesia alone versus local anaesthesia and conscious sedation. The primary outcome of patient satisfaction was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS). The study was powered to detect a significant difference in ISAS scores between groups. Comparisons were made using T test and Chi square tests. A p value of less than 0.05 was considered significant.
There were 149 patients randomized: 78 to the local anesthesia (LA) group and 71 to the local anaesthesia and conscious sedation (LACS) group. For the primary outcome measure of patient satisfaction, the mean ISAS score was significantly greater in the LACS group (p = 0.009). The experience of pain and pain severity was greater in the LA group (p = 0.016; p = 0.0162 respectively). No statistically significant difference was found between groups with respect to operative time, time to discharge or postoperative complications.
The use of conscious sedation with local anesthesia for inguinal hernioplasty is safe, results in less pain experience and severity and is associated with better patient satisfaction. The use of conscious sedation does not delay patient discharge.
KeywordsInguinal hernioplasty Local anesthesia Conscious sedation Patient satisfaction Randomized controlled trial
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest
All procedures followed were in accordance with ethical standards determined by the Faculty of Medical Sciences (UWI) Ethics Committee.
Human and animal rights
All procedures performed involving human participants were in accordance with the ethical standards of the University of the West Indies, the Faculty of Medical Sciences Ethics Committee and with the 1964 Helsinki declaration and it later amendments or comparable ethical standards.
All patients gave written informed consent following a thorough explanation of the study by our research nurse.
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