title: Local anaesthesia versus spinal anaesthesia in inguinal hernia repair: A systematic review and meta-analysis.
abstract: BACKGROUND
  Inguinal hernias are a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of local anaesthesia when compared to spinal anaesthesia in individuals undergoing open inguinal hernia repair.
  
  
  METHODS
  A systematic literature search was conducted. Inclusion criteria were randomised controlled trials (RCTs) comparing spinal and local anaesthesia on clinical and self-reported outcomes, in patients undergoing open inguinal hernia repairs. The methodological quality was assessed using the Cochrane risk of bias tool. The mode of analysis used was the difference in outcomes between the groups post-surgery and at follow-up time points. Statistical heterogeneity was assessed using the I2statistic.
  
  
  RESULTS
  Ten original RCTs were included, with a total of 1379 patients. There was no significant difference in operative time between the groups [Random Effects Model, MD -0.70 min (95% CI, -5.80 to 4.40 min), p = 0.79, I2= 84%]. Patients in the local anaesthetic group experienced significantly less pain than those in the spinal group [Fixed Effects Model, SMD -0.63 (95% CI, -0.81 to -0.46), p < 0.01, I2= 49%], lower rates of urinary retention [FEM, RR 0.03 (95% CI 0.01-0.08), p < 0.01, I2= 0%], decreased rates of anaesthetic failure [FEM, OR 0.17 (95% CI 0.06-0.45), p < 0.01, I2= 0%], and increased satisfaction with the anaesthetic [FEM, OR 3.40 (95% CI 2.09-5.52), p < 0.01, I2= 0%]. The methodological quality of studies was variable.
  
  
  CONCLUSIONS
  Our findings support the use of local anaesthetic in adult patients undergoing open repair for a primary inguinal hernia.
authors.affiliation: Department of Surgical Affairs, Royal College of Surgeons in Ireland, Republic of Ireland. Electronic address: deepaliprakash@nhs.net.
authors.forename: Deepali
authors.initials: D
authors.lastname: Prakash
authors.affiliation: Department of Surgical Affairs, Royal College of Surgeons in Ireland, Republic of Ireland. Electronic address: leonieheskin@rcsi.ie.
authors.forename: Leonie
authors.initials: L
authors.lastname: Heskin
authors.affiliation: Department of Psychology, Royal College of Surgeons in Ireland, Republic of Ireland. Electronic address: sallydoherty@rcsi.ie.
authors.forename: Sally
authors.initials: S
authors.lastname: Doherty
authors.affiliation: Department of Clinical Therapies, University of Limerick, Republic of Ireland. Electronic address: rose.galvin@ul.ie.
authors.forename: Rose
authors.initials: R
authors.lastname: Galvin
mesh_terms: D000772:Anesthesia, Local; D000775:Anesthesia, Spinal; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans
keywords: Anaesthesia; Hernia; Inguinal; Local; Meta-analysis; Spinal; Systematic review