Groin hernia repair: anesthesia.
The choice of anesthesia for groin hernia repair is between general, regional (epidural or spinal), and local anesthesia. Existing data from large consecutive patient series and randomized studies have shown local anesthesia to be the method of choice because it can be performed by the surgeon, does not necessarily require an attending anesthesiologist, translates into the shortest recovery (bypassing the postanesthesia care unit), has the lowest cost, and has the lowest postoperative morbidity regarding risk of urinary retention. Spinal anesthesia has no documented benefits for this small operation and should be avoided owing to the risk of rare neurologic side effects and the high risk of urinary retention. General anesthesia with short-acting agents may be a valid alternative when combined with local infiltration anesthesia, although an anesthesiologist is required. Despite sufficient scientific data to support the choice of anesthesia, large epidemiologic and nationwide information from databases show an undesirable high (about 10-20%) use of spinal anesthesia and low (about 10%) use of local infiltration anesthesia. Surgeons and anesthesiologists should therefore adjust their anesthesia practices to fit the available scientific evidence.
Section of Surgical Pathophysiology 4074, The Juliane Marie Centre, Rigshospitalet, 2100 Copenhagen, Denmark. henrik.kehlet@rh.dk
Henrik
H
Kehlet
Eske
E
Aasvang
D000758:Anesthesia; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000772:Anesthesia, Local; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D013514:Surgical Procedures, Operative