Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair.

STUDY 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.

DESIGN: Randomized, prospective trial.

SETTING: University hospital day-surgery center.

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

INTERVENTIONS: 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.

MEASUREMENTS: 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.

MAIN 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.