Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair.
OBJECTIVE
Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TIVA patients.


METHODS
Randomized, prospective trial.


METHODS
University hospital day-surgery center.


METHODS
156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy.


METHODS
Patients were randomized to either LAI (lidocaine+ropivacaine), SPIN (bupivacaine+fentanyl) or TIVA (propofol+remifentanil). Perioperative Ringer infusion was 1.5mL/h. Urinary bladder was scanned before and after surgery. Interviews were performed on postoperative days 1, 7 and 90.


METHODS
Duration of surgery, duration of the patients' stay in the operating room and time until their readiness for discharge home. Patient satisfaction and adverse effects were registered.


RESULTS
Surgery lasted longer in LAI group (median 40min) than in SPIN group (35min) (P=.003) and TIVA group (33min) (P<.001). Although surgery was shortest in TIVA group, TIVA patients stayed longer in the operating room than LAI patients (P=.001). Time until readiness for discharge was shorter in LAI group (93min) than in TIVA (147min) and SPIN (190min) groups (P<.001). Supplementary lidocaine infiltration was given to 32 LAI patients, and IV fentanyl to 29 LAI and 4 SPIN patients. Ephedrine was required in 34 TIVA, 5 LAI and 5 SPIN patients. One SPIN and three LAI patients had to be given TIVA and another SPIN patient LAI to complete the operations. Urinary retention was absent. Discomfort in the scar (26%) three months postoperatively was not anesthesia-related.


CONCLUSIONS
Logistically, LAI was superior because of the fastest recovery postoperatively. The anesthetic techniques were adequate for surgery in all but a few LAI and SPIN patients. Lack of urinary retention was probably related to the small IV infusion volumes.
Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine; Day-Surgery Center at Surgical Hospital, Helsinki University Central Hospital, PO Box 263, 00029, HUS, Helsinki, Finland. Electronic address: pertti.pere@hus.fi.
Pertti
P
Pere
Division of Gastrointestinal Surgery, Department of Surgery, University of Helsinki, 00014 University of Helsinki; Day-Surgery Center at Surgical Hospital, Helsinki University Central Hospital, PO Box 263, 00029, HUS, Helsinki, Finland.
Jukka
J
Harju
Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine; Day-Surgery Center at Surgical Hospital, Helsinki University Central Hospital, PO Box 263, 00029, HUS, Helsinki, Finland.
Pekka
P
Kairaluoma
Division of Gastrointestinal Surgery, Department of Surgery, University of Helsinki, 00014 University of Helsinki; Day-Surgery Center at Surgical Hospital, Helsinki University Central Hospital, PO Box 263, 00029, HUS, Helsinki, Finland.
Veikko
V
Remes
Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine; Day-Surgery Center at Surgical Hospital, Helsinki University Central Hospital, PO Box 263, 00029, HUS, Helsinki, Finland.
Päivi
P
Turunen
Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine.
Per H
PH
Rosenberg
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000577:Amides / Q000008:administration & dosage; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D005240:Feasibility Studies; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil; D000077212:Ropivacaine; D016055:Urinary Retention / Q000000981:diagnostic imaging / Q000209:etiology
D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010880:Piperidines; D000077212:Ropivacaine; D008012:Lidocaine; D000077208:Remifentanil; D005283:Fentanyl; D002045:Bupivacaine; D015742:Propofol
Day-case surgery; Discharge home; Intravenous general anesthesia; Local anesthetic infiltration; Open inguinal hernia repair; Spinal anesthesia