title: Should we abandon regional anesthesia in open inguinal hernia repair in adults?
abstract: 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.
authors.affiliation: Department of Surgery, General Hospital Karlovac, Karlovac, Croatia. borebakota@yahoo.com.
authors.forename: B
authors.initials: B
authors.lastname: Bakota
authors.affiliation: Department of Surgery, Clinical Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia. mkopljar1972@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Kopljar
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia. drmala33@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Baranovic
authors.affiliation: Department of Surgery, General Hospital Karlovac, Karlovac, Croatia. dr.miletic.matija@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Miletic
authors.affiliation: Department of Surgery, University Hospital Center Rijeka, Rijeka, Croatia. marin.marinovic2@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Marinovic
authors.affiliation: Department of Surgery, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia. dinko.vidovic@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Vidovic
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome