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Improving patient outcomes with inguinal hernioplasty—local anaesthesia versus local anaesthesia and conscious sedation: a randomized controlled trial

  • P.-A. LeakeEmail author
  • P. Toppin
  • M. Reid
  • J. Plummer
  • P. Roberts
  • H. Harding-Goldson
  • M. McFarlane
Original Article
Part of the following topical collections:
  1. Forum on primary monolateral uncomplicated inguinal hernia



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.


Inguinal hernioplasty Local anesthesia Conscious sedation Patient satisfaction Randomized controlled trial 



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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of General Surgery, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical SciencesUniversity of the West Indies, MonaKingston 7Jamaica
  2. 2.Division of Anaesthesia, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical SciencesUniversity of the West Indies, MonaKingston 7Jamaica
  3. 3.Tropical Metabolic Research InstituteUniversity of the West Indies, MonaKingston 7Jamaica

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