Should we abandon regional anesthesia in open inguinal hernia repair in adults?

European Journal of Medical Research, Sep 2015

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.

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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 - 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. © 2015 Bakota et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 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)


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B. Bakota, M. Kopljar, S. Baranovic, M. Miletic, M. Marinovic, D. Vidovic. Should we abandon regional anesthesia in open inguinal hernia repair in adults?, European Journal of Medical Research, 2015, pp. 76, 20, DOI: 10.1186/s40001-015-0170-0