title: Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphy.
abstract: The use of an ilioinguinal-hypogastric nerve block (IHNB) as part of a monitored anesthesia care (MAC) technique has been associated with a rapid recovery profile for outpatients undergoing inguinal herniorrhaphy procedures. This study was designed to compare the cost-effectiveness of an IHNB-MAC technique with standardized general and spinal anesthetics techniques for inguinal herniorrhaphy in the ambulatory setting. We randomly assigned 81 consenting outpatients to receive IHNB-MAC, general anesthesia, or spinal anesthesia. We evaluated recovery times, 24-h postoperative side effects and associated incremental costs. Compared with general and spinal anesthesia, patients receiving IHNB-MAC had the shortest time-to-home readiness (133+/-68 min vs. 171+/-40 and 280+/-83 min), lowest pain score at discharge (15+/-14 mm vs. 39+/-28 and 34+/-32 mm), and highest satisfaction at 24-h follow-up (75% vs. 36% and 64%). The total anesthetic costs were also the least in the IHNB-MAC group ($132.73+/-33.80 vs. $172.67+/-29.82 and $164.97+/-31.03). We concluded that IHNB-MAC is the most cost-effective anesthetic technique for outpatients undergoing unilateral inguinal herniorrhaphy with respect to speed of recovery, patient comfort, and associated incremental costs.
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
authors.forename: D
authors.initials: D
authors.lastname: Song
authors.forename: N B
authors.initials: NB
authors.lastname: Greilich
authors.forename: P F
authors.initials: PF
authors.lastname: White
authors.forename: M F
authors.initials: MF
authors.lastname: Watcha
authors.forename: W K
authors.initials: WK
authors.lastname: Tongier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects / Q000191:economics*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000191:economics; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000294:innervation; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000191:economics; D010147:Pain Measurement; D010149:Postoperative Pain / Q000145:classification; D010351:Patient Discharge; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage; D012119:Respiration / Q000187:drug effects; D013997:Time Factors
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008012:Lidocaine; D005283:Fentanyl; D002045:Bupivacaine; D015742:Propofol