title: Local or general anesthesia for open hernia repair: a randomized trial.
abstract: OBJECTIVE
  To compare patient outcome following repair of a primary groin hernia under local (LA) or general anesthesia (GA) in a randomized clinical trial.
  
  
  BACKGROUND
  LA hernia repair is thought to be safer for patients, causes less postoperative pain, cost less, and is associated with a more rapid recovery when compared with the same operation performed under GA.
  
  
  METHODS
  All patients presenting to three surgeons during the study period with a primary groin hernia were considered eligible. Outcome parameters measured including tests of vigilance, divided attention, sustained attention, memory, cognitive function, pain, return to normal activity, and costs.
  
  
  RESULTS
  Two hundred seventy-nine patients were randomized to LA or GA hernia repair; 276 of these had an operation, with 138 participants in each group. At 6, 24, and 72 hours postoperatively there were no differences in vigilance or divided attention between the groups. Similarly, memory, sustained attention, and cognitive function were not impaired in either group. Although physical activity was significantly impaired at 24 hours, this and return to usual social activities were similar in both groups. While patients in the LA group had significantly less pain on moving, at 6 hours they were less likely to recommend the same operation to someone else. GA hernia repair cost 4% more than the same operation under LA.
  
  
  CONCLUSIONS
  There are no major differences in patient recovery after LA or GA hernia repair. Patients should be offered a choice of anesthesia, LA or GA, for repair of their groin hernia.
authors.affiliation: University Department of Surgery, Western Infirmary and Royal Infirmary, Glasgow G211 6NT, Scotland, UK. p.j.odwyer@clinmed.gla.uk
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Dwyer
authors.forename: Michael G
authors.initials: MG
authors.lastname: Serpell
authors.forename: Keith
authors.initials: K
authors.lastname: Millar
authors.forename: Caron
authors.initials: C
authors.lastname: Paterson
authors.forename: David
authors.initials: D
authors.lastname: Young
authors.forename: Alan
authors.initials: A
authors.lastname: Hair
authors.forename: Carol-Ann
authors.initials: CA
authors.lastname: Courtney
authors.forename: Paul
authors.initials: P
authors.lastname: Horgan
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kumar
authors.forename: Andrew
authors.initials: A
authors.lastname: Walker
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
mesh_terms: D000768:Anesthesia, General; D000772:Anesthesia, Local; D005260:Female; D005500:Follow-Up Studies; D006550:Hernia, Femoral / Q000601:surgery*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction