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      Comparison of spinal anesthesia and general anesthesia in inguinal hernia repair in adult: a systematic review and meta-analysis

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          Abstract

          Background

          Inguinal hernia repair is one of the most commonly performed surgical procedures. To date, there is no consensus on which anesthesia should be used. The objective of this meta-analysis was to assess the efficacy of spinal anesthesia (SA) vs. general anesthesia (GA) in inguinal hernia repair in adults.

          Methods

          Eligible studies were identified before January 2020 from PubMed, Embase, ScienceDirect, Cochrane Library, Scopus database as well as reference lists. Outcomes included surgery time, the time in the operation room, the length of hospital stay, pain scores, patient satisfaction, and postoperative complications. Subgroup analysis based on surgical approaches was conducted.

          Results

          Six randomized controlled trials (RCT) and five cohort studies were included. A total of 2593 patients were analyzed. Compared to GA, SA was associated with a longer surgery time (weighted mean difference [WMD]: − 3.28, 95%confident interval [CI]: − 5.76, − 0.81), particularly in laparoscopic repair. Postoperative pain at 4 h and 12 h were in favor of SA following either open or laparoscopic repairs (standard mean difference [SMD]: 1.58; 95%CI: 0.55, 2.61, SMD: 0.99, 95%CI: 0.37, 1.60, respectively); and considering borderline significance, patients receiving SA might be more satisfied with the anesthesia they used for herniorrhaphy (SMD: -0.32, 95%CI: − 0.70, 0.06). Some major complications of scrotal edema, seroma, wound infection, recurrence, shoulder pain were comparable between the two groups. However, patients receiving SA had an increased risk of postoperative urinary retention and headache when compared with GA (relative ratio [RR]: 0.44, 95% CI: 0.23, 0.86, RR: 0.33, 95% CI: 0.12, 0.92, respectively). There was a tendency that the incidence of postoperative nausea and vomiting was lower in SA than GA (RR: 2.12, 95%CI: 0.95, 4.73), especially in open herniorrhaphy.

          Conclusions

          SA can be another good choice for pain relief no matter in open or laparoscopic hernia repairs, but it can’t be confirmed that SA is better than GA.

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          Most cited references23

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          Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients.

          P. MYLES, Paul H. Anderson, A Weeks … (1999)
          Patient satisfaction after anaesthesia is an important outcome of hospital care. We analysed our anaesthetic database to identify potentially modifiable factors associated with dissatisfaction. At the time of analysis, our database contained information on 10,811 in-patients interviewed on the first day after operation. The major subjective outcome measure was patient satisfaction. We also measured other predetermined outcomes, such as nausea, vomiting, pain and complications. The overall level of satisfaction was high (96.8%); 246 (2.3%) patients were 'somewhat dissatisfied' and 97 (0.9%) were 'dissatisfied' with their anaesthetic care. After adjustment for patient and surgical factors, there was a strong relation between patient dissatisfaction and: (i) intraoperative awareness (odds ratio (OR) 54.9, 95% confidence intervals (CI) 15.7-191); (ii) moderate or severe postoperative pain (OR 3.94, 95% CI 3.16-4.91); (iii) severe nausea and vomiting (OR 4.09, 95% CI 3.18-5.25); and (iv) any other postoperative complications (OR 2.04, 95% CI 1.61-2.56). Several factors associated with dissatisfaction may be preventable or better treated.
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            Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial.

            S Rajeshwari, Subodh Kumar, Asuri Krishna … (2012)
            Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the "best groin hernia repair." The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair. The present prospective randomized study was conducted between May 2007 and March, 2009 and included 100 patients suffering from uncomplicated primary groin hernia. Patients were randomized into group I (TEP) and group II (TAPP). Intraoperative variables and postoperative pain scores were recorded in a prestructured form. One hundred patients were included in the study (TEP, 53; TAPP, 47). Both groups were comparable in terms of demographic profile and hernia characteristics. The average operative time was higher in the TAPP group (p = 0.209). The pain scores at 1 h and 24 h after surgery and at 3-month follow-up were significantly higher in the TAPP group (p < 0.05). The average follow-up was 30.5 months. In the TEP group, 37.8% of patients had seroma compared to 18.3% in the TAPP group (p = 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (16 vs. 9, p = 0.009). The wound infection rates were equal (2% vs. 3%). There has been no recurrence in either group during the follow-up period of 44 months. Overall, the patients were more satisfied with TEP rather than TAPP (p < 0.05). In the present study, TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.
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              Anaesthesia and post-operative morbidity after elective groin hernia repair: a nation-wide study.

              H Kehlet, Steven M. Bay (2008)
              Randomised studies suggest regional anaesthesia to have the highest morbidity and local infiltration anaesthesia to have the lowest morbidity after groin hernia repair. However, implications and results of this evidence for general practice are not known. Prospective nation-wide data collection in a cohort of n=29,033 elective groin hernia repairs, registered in the Danish Hernia Database in three periods, namely July 1998-June 1999, July 2000-June 2001 and July 2002-June 2003. Retrospective analysis of complications in discharge abstracts, identified from re-admission within 30 days post-operatively, prolonged length of stay (>2 days post-operatively) or death. Complications after groin hernia repair were more frequent in patients 65+ years (4.5%), compared with younger patients (2.7%) (P<0.001). In patients 65+ years, medical complications were more frequent after regional anaesthesia (1.17%), compared with general anaesthesia (0.59%) (P=0.003) and urological complications were more frequent after regional anaesthesia (0.87%), compared with local infiltration anaesthesia (0.09%) (P=0.006). Seventeen prostatectomies occurred after post-operative urinary retention, but with no case after local anaesthesia. Mortality within 30 days after elective groin hernia repair was 0.12%. Regional anaesthesia was disproportionately more often used in patients dying within 1 week post-operatively. Choice of the anaesthetic technique should be adjusted to available procedure-specific scientific evidence and the use of regional anaesthesia in elderly patients undergoing groin hernia repair is not supported by existing evidence.
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Xiangchao Meng: XiangchaoMeng@yeah.net
                Journal
                Journal ID (nlm-ta): BMC Anesthesiol
                Journal ID (iso-abbrev): BMC Anesthesiol
                Title: BMC Anesthesiology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2253
                Publication date (Electronic): 10 March 2020
                Publication date PMC-release: 10 March 2020
                Publication date Collection: 2020
                Volume: 20
                Electronic Location Identifier: 64
                Affiliations
                GRID grid.417032.3, ISNI 0000 0004 1798 6216, Department of Thyroid, Breast, Hernia Surgery, , Tianjin the third Central Hospital, ; NO.83, Jintang Road, Tianjin, 300170 China
                Article
                Publisher ID: 980
                DOI: 10.1186/s12871-020-00980-5
                PMC ID: 7065351
                PubMed ID: 32156258
                SO-VID: f39d872c-2cf2-4648-aee8-faa845e3b255
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 1 August 2019
                Date accepted : 4 March 2020
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: inguinal hernia repair,spinal anesthesia,general anesthesia,meta-analysis
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: inguinal hernia repair, spinal anesthesia, general anesthesia, meta-analysis

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