Abstract
BackgroundInguinal 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.MethodsEligible 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.ResultsSix 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.ConclusionsSA 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.
Highlights
Inguinal hernia repair is one of the most commonly performed surgical procedures
Four cohorts reported patient satisfaction and the pooled Standardized mean difference (SMD) was − 0.32 (95%Confidence intervals (CI): − 0.70, 0.06, I2 = 77.5%, P = 0.10), indicating a trend that patients receiving spinal anesthesia (SA) were more satisfied with the anesthesia they used for herniorrhaphy as compared to general anesthesia (GA) (Fig. 7)
We found the incidences of scrotal edema, seroma, wound infection, recurrence, and shoulder pain were comparable between the two groups irrespective of laparoscopic or open repairs
Summary
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. The choice of anesthetic techniques ranges from local infiltration to regional block to general endotracheal. The most commonly used regional anesthesia technique is spinal anesthetic (SA), which has the advantage of avoiding paralytic agents and endotracheal intubation [3]. To date, no pooled analyses of the results focusing on the comparison between SA and GA in adults have surfaced The purpose of this meta-analysis was to assess the efficacy of SA vs GA in inguinal hernia repair in adults, in terms of surgery time, the time in operation room, hospital stay, pain scores, patient satisfaction, and major postoperative complications
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