Should we abandon regional anesthesia in open inguinal hernia repair in adults?
Bakota et al. Eur J Med Res
Should we abandon regional anesthesia in open inguinal hernia repair in adults?
B. Bakota 2
M. Kopljar 0
S. Baranovic 1
M. Miletic 2
M. Marinovic 4
D. Vidovic 3
0 Department of Surgery, Clinical Hospital Dubrava , Av. Gojka Suska 6, 10000 Zagreb , Croatia
1 Department of Anesthesiology and Intensive Care Unit, University Hospital Center “Sestre Milosrdnice” , Zagreb , Croatia
2 Department of Surgery, General Hospital Karlovac , Karlovac , Croatia
3 Depart- ment of Surgery, University Hospital Center “Sestre Milosrdnice” , Zagreb , Croatia
4 Depart- ment of Surgery, University Hospital Center Rijeka , Rijeka , Croatia
Inguinal hernia repair is a common worldwide surgical procedure usually done in the outpatient setting. The purpose of this systematic review is to make an evidence-based meta-analysis to determine the possible benefits of regional (neuraxial block) anesthesia compared to general anesthesia in open inguinal hernia repair in adults. Cochrane Library, Medline, EMBASE, CINAHL, SCI-EXPANDED, SCOPUS as well as trial registries, conference proceedings and reference lists were searched. Only randomized controlled trials (RCT) that compare neuraxial block (spinal or/and epidural) anesthesia (NABA) and general anesthesia (GA) were included. Main outcome measures were postoperative complications, urinary retention and postoperative pain. Seven RCTs were included in this review. A total of 308 patients were analyzed with 154 patients in each group. Overall complications were evenly distributed in NABA and in GA group [OR 1.17, 95 % CI (0.52-2.66)]. Urinary retention was statistically less frequent in GA group compared to NABA group [OR 0.25, 95 % CI (0.08-0.74)]. Movement-associated pain score 24 h after surgery was significantly lower in NABA group [SMD 5.59, 95 % CI (3.69-7.50)]. Time of first analgesia application was shorter in GA group [SMD 8.99, 95 % CI 6.10-11.89]. Compared to GA, NABA appears to be a more adequate technique in terms of postoperative pain control. However, when GA is applied, patients seem to have less voiding problems.
Hernia; Meta-analysis; Systematic review; Regional anesthesia; General anesthesia; Complications
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Background
Inguinal hernia repair is one of the most common
procedures in general surgery performed with the
estimation of a 20 million surgeries per year [1]. Local (LA),
regional (RA) or general anesthesia (GA) enable the
variety of surgical procedures for open inguinal hernia
in adults, in which, according to the data from Scotland
[2], Sweden [3] and Danish Hernia Database
collaboration [4, 5], GA has a frequency of 60-70 %, RA 10-20 %
and LA 10 %. In spite of current Danish Hernia Database
recommendations that RA (spinal or epidural) should be
abandoned [6], it is still used in 10-20 % of procedures
[1, 7]. Although the current literature does not favor the
use of RA, there are still no clear
guidelines/evidencebased proof to abandon it. The purpose of this
systematic review is to make evidence-based analysis in order
to determine the possible benefits of regional (neuraxial
block) anesthesia (NABA) in open inguinal hernia repair
in adults. Within this meta-analysis, we compared NABA
with GA as the most frequent type of anesthesia used in
open inguinal hernia repair in adults [1, 5, 8].
Review
We applied the methods according to Cochrane
Collaboration standards [9] and to the protocol published [10].
The inclusion criteria were randomized controlled trials
(RCT) only, that compare neuraxial (spinal and/or
epidural) block anesthesia (NABA) with general anesthesia
(GA) for open inguinal hernia repair in adults,
irrespective of the language reported on. All the patients with a
clinical diagnosis of inguinal hernia, which involves
primary inguinal hernia, unilateral, bilateral or recurrent
hernia that had an indication for an appropriate surgical
management, were included.
Publications with repeated results together with
double publications were excluded from this study. Studies
that included a double anesthetic procedure to the same
group of patients were also excluded.
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We defined complications, urinary retention and
postoperative pain as the main outcome measures.
Complications: Major complications included
significant respiratory and circulatory complications (hyper/
hypotension) as well as other potentially life-threatening
visceral and (...truncated)