Abstract
Inguinal hernia repair is a common worldwide surgical procedure usually done in the outpatient setting. The purpose of this systematic review is to make an evidence-based meta-analysis to determine the possible benefits of regional (neuraxial block) anesthesia compared to general anesthesia in open inguinal hernia repair in adults. Cochrane Library, Medline, EMBASE, CINAHL, SCI-EXPANDED, SCOPUS as well as trial registries, conference proceedings and reference lists were searched. Only randomized controlled trials (RCT) that compare neuraxial block (spinal or/and epidural) anesthesia (NABA) and general anesthesia (GA) were included. Main outcome measures were postoperative complications, urinary retention and postoperative pain. Seven RCTs were included in this review. A total of 308 patients were analyzed with 154 patients in each group. Overall complications were evenly distributed in NABA and in GA group [OR 1.17, 95 % CI (0.52–2.66)]. Urinary retention was statistically less frequent in GA group compared to NABA group [OR 0.25, 95 % CI (0.08–0.74)]. Movement-associated pain score 24 h after surgery was significantly lower in NABA group [SMD 5.59, 95 % CI (3.69–7.50)]. Time of first analgesia application was shorter in GA group [SMD 8.99, 95 % CI 6.10–11.89]. Compared to GA, NABA appears to be a more adequate technique in terms of postoperative pain control. However, when GA is applied, patients seem to have less voiding problems.
Highlights
Inguinal hernia repair is one of the most common procedures in general surgery performed with the estimation of a 20 million surgeries per year [1]
Local (LA), regional (RA) or general anesthesia (GA) enable the variety of surgical procedures for open inguinal hernia in adults, in which, according to the data from Scotland [2], Sweden [3] and Danish Hernia Database collaboration [4, 5], GA has a frequency of 60-70 %, regional anesthesia (RA) 10-20 % and local anesthesia (LA) 10 %
After we have eliminated the studies repeated in different databases, a 6711 potentially relevant articles for further analysis remained
Summary
Inguinal hernia repair is one of the most common procedures in general surgery performed with the estimation of a 20 million surgeries per year [1]. Local (LA), regional (RA) or general anesthesia (GA) enable the variety of surgical procedures for open inguinal hernia in adults, in which, according to the data from Scotland [2], Sweden [3] and Danish Hernia Database collaboration [4, 5], GA has a frequency of 60-70 %, RA 10-20 % and LA 10 %. In spite of current Danish Hernia Database recommendations that RA (spinal or epidural) should be abandoned [6], it is still used in 10-20 % of procedures [1, 7]. The inclusion criteria were randomized controlled trials (RCT) only, that compare neuraxial (spinal and/or epidural) block anesthesia (NABA) with general anesthesia (GA) for open inguinal hernia repair in adults, irrespective of the language reported on. All the patients with a clinical diagnosis of inguinal hernia, which involves primary inguinal hernia, unilateral, bilateral or recurrent hernia that had an indication for an appropriate surgical management, were included
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