Subarachnoid anesthesia vs monitored anesthesia care for outpatient unilateral inguinal herniorrhaphy.
OBJECTIVE
Inguinal herniorrhaphy is one of the most commonly performed surgical procedures in a same-day surgery setting. The prerequisite of having to discharge the surgical outpatient on the same day has an influence on the choice of the anesthetic technique.


METHODS
A randomized clinical trial was performed on 100 outpatients; 50 patients were enrolled in the subarachnoid anesthesia (SA) group and 50 patients in the monitored anesthesia care (MAC) group. Patients in the MAC group received local anesthesia plus target-controlled infusion propofol (LA+TCI). SA was performed using 7.5 mg 0.5% hyperbaric bupivacaine according to the selective technique. In the LA+TCI group, LA was performed with 20 mL 1% mepivacaine + 10 mL 1% ropivacaine; IV propofol sedation using TCI according to Schnider was used to obtain a Ramsay scale response of 4-5. Transferability from the operating room was evaluated based on an Aldrete score > or =9; ability to discharge from the health facility was evaluated based on a Post-Anesthesia Discharge Scoring System (PADSS) > or =9.


RESULTS
Of the 100 total patients enrolled, five drop-outs were recorded in the SA group. By comparing the LA+TCI and SA groups, it was determined that the time to an Aldrete > or =9 score from the end of the procedure was 25+/-27 vs 34+/-54 min (P=0.330); the time to a PADSS 9 score was 113+/-58 vs 181+/-65 min (P<0.001); actual discharge occurred after 236+/-83 vs 289+/-78 min (P<0.01).


CONCLUSIONS
LA+TCI was shown to be more effective than selective SA at low doses in terms of shorter time to recovery after unilateral inguinal herniorrhaphy procedures.
Poli
M
M
Department of Anesthesia, Intensive Care Unit and Antalgic Therapy, Civile Nuovo Hospital, Imola, Italy. poli_michela@tin.it
Biscione
R
R
Bacchilega
I
I
Saravo
L
L
Trombetti
P
P
Amelio
G
G
Rossi
G
G
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000758:Anesthesia; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013346:Subarachnoid Space
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local