1598 Local Anaesthetic or General Anaesthetic: The Optimal Choice for Inguinal Hernia Repair

Abstract

Abstract Aim Inguinal hernias occur when visceral tissue protrudes through the inguinal canal [1]. Around 20 million inguinal hernia repairs (IHR) are done annually worldwide and involve re-enforcement of the compromised wall of the inguinal canal using polypropylene mesh via open anterior approach or minimally invasive laparoscopy [2,3]. Despite gold standards in surgical approach, there’s no distinctively superior practice between local anaesthetic (LA) and general anaesthetic (GA). Therefore, the objective was to review IHR under both LA and GA and investigate which method is conductive to optimal patient outcomes. Method Systematically reviewed randomised control trials (RCTs) evaluating the benefits of LA over GA in IHR, by comparing factors such as post-operative nausea, urinary retention (UR), haematoma, wound infection (WI), pain, and operating time. PubMed was utilised for finding suitable studies, and data was obtained and summarised appropriately. Results Data assembled from RCTs evaluating benefits of LA over GA in IHR indicated no significant difference between groups when comparing nausea, UR, haematoma, WI and pain [4]. Supporting studies reviewing RCTs juxtaposing GA and LA in IHR elucidated no significant variance in operating time, haematoma and WI [5]. Patients did show less rates of UR, reduced pain scores and greater patient satisfaction under LA [5]. Conclusions LA is used in specialised hernia clinics due to less cardiovascular risk however development of short-acting GA’s allows for suitability for day-case surgery. Future investigation is required taking into account factors like surgeon experience, patient anatomy and economic viability for a definitive gold standard.