Anesthesia For Inguinal Hernia Repair Research Articles

A Retrospective Observational Study of Post-Induction Low Systolic Blood Pressure and Associated Patient and Perioperative Factors in Infants Undergoing General Anesthesia for Inguinal Hernia Repair

A Retrospective Observational Study of Post-Induction Low Systolic Blood Pressure and Associated Patient and Perioperative Factors in Infants Undergoing General Anesthesia for Inguinal Hernia Repair

Feasibility and Efficacy of Desarda vs Lichtenstein Hernioplasty by Local Anesthesia for Inguinal Hernia Repair: A Noninferiority Randomized Clinical Trial

Introduction: Lichtenstein repair is a standard open technique for inguinal hernia but needs a prosthesis, increasing cost and complication. Conversely, Desarda autologous tissue repair is reported to have comparable results. This study aims to compare the efficacy of Desarda repair (DR) with Lichtenstein’s hernioplasty (LH) and establish the feasibility of operation under local anaesthesia (LA). Methods: This study was a prospective, double-blinded, non-inferiority randomized trial in patients undergoing open inguinal hernia repair under LA [NCT03512366]. The non-inferiority margin fixed was 0.5 days. The primary endpoint was time to return to the normal gait with comfort postoperative. The secondary endpoints studied were the incidence of surgical site occurrences (SSO), including recurrence. Results: The cohort comprised 56 patients (50.9%) in the DR group and 54 patients (49.1%) in the LH group. All the procedures were safely performed under LA. By intention-to-treat analysis, the median (interquartile range) duration for resuming gait post-surgery with comfort was 5 (interquartile range [IQR], 3-8) days in the DR vs 4 (IQR, 3-7) days in the LH arm (P = 0.16), thereby failing to demonstrate the noninferiority. There was no significant difference in days to return to work, surgical site occurrences, chronic groin pain, and two years recurrence rates. Conclusion: This study could not statistically prove the noninferiority of Desarda repair compared with Lichtenstein hernioplasty for resuming normal gait. Still, comparing the days to return to work, pain score, chronic groin pain and recurrence rate, Desarda repair faired equally with Lichtenstein hernioplasty, thereby highlighting its feasibility under local anaesthesia and efficacy.

Impact of supplemental anesthesia in preterm infants undergoing inguinal hernia repair under spinal anesthesia : Aretrospective analysis.

In preterm infants, spinal anesthesia (SpA) is recognized as an alternative to general anesthesia for inguinal hernia repair (IHR); however, some patients require supplemental anesthesia during surgery. The purpose of this study was to investigate the frequency and impact of supplemental anesthesia on perioperative care and adverse respiratory and hemodynamic events. A retrospective study of preterm infants undergoing IHR at Heidelberg University Hospital within the first year of life between 2009 and 2018 was carried out. In total, 230 patients (255 surgeries) were investigated. Among 189 procedures completed using SpA 24patients received supplemental anesthesia. Reasons for supplemental anesthesia included loss of anesthetic effect, returning motor response, and respiratory complications. Compared to SpA alone, no differences were found concerning hemodynamic parameters; however, patients requiring supplemental anesthesia displayed higher rates of postoperative oxygen supplementation and unexpected admission to the intensive care unit. The rate of perioperative apnea was 2.7%. Apneic events exclusively occurred after supplemental anesthesia. Bilateral IHR and duration of surgery were associated with the need for supplemental anesthesia. Whereas SpA might be favorable when compared to general anesthesia for IHR, the data indicate that particular caution is required in patients receiving supplemental anesthesia due to the possible risk for adverse respiratory events.

Anesthesia for inguinal hernia repair: Experience with a tertiary hospital-based surgical outreach in a developing world.

Background:The dearth of adequate facilities and anesthetists limits the number and extent of surgical cases that can be attended to in surgical outreach programs. Inguinal hernia remains a common health burden in the developing world. Tertiary hospitals provide good anesthetic complements to safe surgeries and will be a veritable tool in surgical outreaches.Objectives:The objective of the study is to assess the types/techniques of anesthesia used in uncomplicated open inguinal hernia repair in a tertiary hospital-based surgical outreach program.Materials and Methods:This study was a prospective analysis of anesthetic techniques used in all uncomplicated inguinal hernia repairs performed in outreach program over 1 week in May 2018. Data were collected with a pro forma, analyzed with SPSS, and presented in tables and figures.Results:One hundred and ninety-five patients with uncomplicated inguinal hernias were recruited for the study. The patients’ age ranged from 0 to 89 years, with a mean age of 33.62 ± 22.75 years. Most cases occurred in children. The male-to-female ratio was 7:1, and the majority were primary hernia repairs. Eighty-seven (44.6%) patients had local anesthesia (LA), 65 (33.3%) had general anesthesia (GA), while 43 (22.1%) had spinal anesthesia (SA). One hundred and sixty-two (83.1%) patients needed intraoperative analgesic augmentation. One hundred and sixty-nine (86.7%) patients were operated as day-case surgeries, while 26 (13.3%) patients were discharged the day after surgery. The failure rate of LA and SA put together was 74.6%, but there was no conversion to GA. Anesthetic complication was observed in 3.4% of cases.Conclusion:Organizing inguinal hernia repair outreach in a tertiary hospital offers the benefit of a full complement of anesthesia, which ensures safe and smooth surgery with low anesthetic complications. Most cases were done as daycare surgeries despite the high failure rate of LA and SA.

Use of local anesthesia for inguinal hernia repair has decreased over time in the VA system.

In 2003, randomized trials demonstrated potentially improved outcomes when local instead of general anesthesia is used for inguinal hernia repair. Our study aimed to evaluate how the use of local anesthesia for this procedure changed over time following the publication of the trials' level 1 evidence. We used the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database to identify adults who underwent open, unilateral inguinal hernia repair under local or general anesthesia. Our primary outcome was the percentage of cases performed under local anesthesia. We used a time-series design to examine the trend and rate of change of the use of local anesthesia. We included 97,437 veterans, of which 22,333 (22.9%) had hernia surgery under local anesthesia. The median age of veterans receiving local anesthesia remained stable at 64-67years over time. The use of local anesthesia decreased steadily, from 38.2% at the beginning year to 15.1% in the final year (P < 0.0001). The publication of results from randomized trials (in 2003) did not appear to increase the overall use or change the rate of decline in the use of local anesthesia. Overall, we found that the use of local anesthesia decreased by about 1.5% per year. The utilization of local anesthesia for inguinal hernia repair in the VA has steadily declined over the last 20 + years, despite data showing equivalence or superiority to general anesthesia. Future studies should explore barriers to the use of local anesthesia for hernia repair.

Racial and Ethnic Disparities in Access to Local Anesthesia for Inguinal Hernia Repair

Many studies have identified racial disparities in healthcare, but few have described disparities in the use of anesthesia modalities. We examined racial disparities in the use of local versus general anesthesia for inguinal hernia repair. We hypothesized that African American and Hispanic patients would be less likely than Caucasians to receive local anesthesia for inguinal hernia repair. We included 78,766 patients aged ≥ 18 years in the Veterans Affairs Surgical Quality Improvement Program database who underwent elective, unilateral, open inguinal hernia repair under general or local anesthesia from 1998-2018. We used multiple logistic regression to compare use of local versus general anesthesia and 30-day postoperative complications by race/ethnicity. In total, 17,892 (23%) patients received local anesthesia. Caucasian patients more frequently received local anesthesia (15,009; 24%), compared to African Americans (2353; 17%) and Hispanics (530; 19%), P < 0.05. After adjusting for covariates, we found that African Americans (OR 0.82, 95% CI 0.77-0.86) and Hispanics (OR 0.77, 95% CI 0.69-0.87) were significantly less likely to have hernia surgery under local anesthesia compared to Caucasians. Additionally, local anesthesia was associated with fewer postoperative complications for African American patients (OR 0.46, 95% CI 0.27-0.77). Although local anesthesia was associated with enhanced recovery for African American patients, they were less likely to have inguinal hernias repaired under local than Caucasians. Addressing this disparity requires a better understanding of how surgeons, anesthesiologists, and patient-related factors may affect the choice of anesthesia modality for hernia repair.

Using local rather than general anesthesia for inguinal hernia repair may significantly reduce complications for frail Veterans

BackgroundFrailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty. MethodsWe used the Risk Analysis Index (RAI) to identify 8,038 frail patients in the 1998–2018 Veterans Affairs Surgical Quality Improvement Program database who underwent elective, open unilateral inguinal hernia repair under local or general anesthesia. Our outcome of interest was the incidence of postoperative complications. ResultsIn total, 5,188 (65%) patients received general anesthesia and 2,850 (35%) received local. Local anesthesia was associated with a 48% reduction in complications (OR 0.52, 95%CI 0.38–0.72). Among the frailest patients (RAI≥70), predicted probability of a postoperative complication ranged from 22 to 33% with general anesthesia, compared to 13–21% with local. ConclusionsLocal anesthesia was associated with a ∼50% reduction in postoperative complications in frail Veterans. Given the paucity of interventions for frail patients, there is an urgent need for a randomized trial comparing effects of anesthesia modality on postoperative complications in this vulnerable population.

Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients

BackgroundInguinal hernia repair is the most common general surgery operation in the United States. Nearly 80% of inguinal hernia operations are performed under general anesthesia versus 15%-20% using local anesthesia, despite the absence of evidence for the superiority of the former. Although patients aged 65 y and older are expected to benefit from avoiding general anesthesia, this presumed benefit has not been adequately studied. We hypothesized that the benefits of local over general anesthesia for inguinal hernia repair would increase with age. Materials and methodsWe analyzed 87,794 patients in the American College of Surgeons National Surgical Quality Improvement Project who had elective inguinal hernia repair under local or general anesthesia from 2014 to 2018, and we used propensity scores to adjust for known confounding. We compared postoperative complications, 30-day readmissions, and operative time for patients aged <55 y, 55-64 y, 65-74 y, and ≥75 y. ResultsUsing local rather than general anesthesia was associated with a 0.6% reduction in postoperative complications in patients aged 75+ y (95% CI –0.11 to –1.13) but not in younger patients. Local anesthesia was associated with faster operative time (2.5 min - 4.7 min) in patients <75 y but not in patients aged 75+ y. Readmissions did not differ by anesthesia modality in any age group. Projected national cost savings for greater use of local anesthesia ranged from $9 million to $45 million annually. ConclusionsSurgeons should strongly consider using local anesthesia for inguinal hernia repair in older patients and in younger patients because it is associated with significantly reduced complications and substantial cost savings.

The Unspoken Question!

The Unspoken Question!

Using local rather than general anesthesia for inguinal hernia repair is associated with shorter operative time and enhanced postoperative recovery

BackgroundInguinal hernia repair is the most common general surgery procedure and can be performed under local or general anesthesia. We hypothesized that using local rather than general anesthesia would improve outcomes, especially for older adults. MethodsThis is a retrospective review of 97,437 patients in the Veterans Affairs Surgical Quality Improvement Program who had open inguinal hernia surgery under local or general anesthesia. Outcomes included 30-day postoperative complications, operative time, and recovery time. ResultsOur cohort included 22,333 (23%) Veterans who received local and 75,104 (77%) who received general anesthesia. Mean age was 62 years. Local anesthesia was associated with a 37% decrease in the odds of postoperative complications (95% CI 0.54–0.73), a 13% decrease in operative time (95% CI 17.5–7.5), and a 27% shorter recovery room stay (95% CI 27.5–25.5), regardless of age. ConclusionsUsing local rather than general anesthesia is associated with a profound decrease in complications (equivalent to “de-aging” patients by 30 years) and could significantly reduce costs for this common procedure.

Three-step tumescent local anesthesia technique for inguinal hernia repair.

The optimal method of anesthesia for inguinal hernia repair is still controversial. We have developed “three‐step tumescent local anesthesia (TLA) technique” for inguinal hernia repair, and recently showed that this technique is acceptable in view of short‐ and long‐term clinical outcomes. Our study included 273 consecutive cases (290 sides) of elective inguinal hernia repair performed under the newly developed technique between September 2003 and May 2019, and overall clinical outcomes were considered to be safe and feasible. Herein, we report the surgical procedure of “three‐step TLA technique.” Briefly, we rapidly inject the diluted solution of local anesthetic and epinephrine step‐by‐step into the three following closed tissue space. Initially, 80 mL injection into the subcutaneous tissue before skin incision (Step 1). After the external oblique fascia is exposed, injection of 20 mL into the inguinal canal before the external oblique fascia is incised and opened (Step 2). The hernia sac and spermatic cord are then dissected, and the blunt dissection of the preperitoneal space is made by injecting 20 mL under the internal inguinal ring (Step 3), followed by placing a gauze into the preperitoneal space, creating the space for mesh placement. We consider that the most important point of this technique is achieved through the rapid injection of TLA solution into each closed tissue space, which makes for easier dissection, hemostasis, and good pain control.

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

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.

A Comparative Study of Anaesthetic Efficacy of 0.75% Ropivacaine and 0.75% Ropivacaine with Dexmedetomidine in Epidural Anaesthesia for Inguinal Hernia Repair

A Comparative Study of Anaesthetic Efficacy of 0.75% Ropivacaine and 0.75% Ropivacaine with Dexmedetomidine in Epidural Anaesthesia for Inguinal Hernia Repair

Impact of institutional hernia programme on guideline conformity of surgical approach and mode of anesthesia for inguinal hernia repair and analysis of the outcomes

AIM: The objective of this study is to elucidate the guideline conformity of surgical approach and mode of anesthesia for inguinal hernia (IH) treatment together with analysis of the outcomes on the implementation of “guideline-based treatment for IH” as a part of institutional hernia programme (IHP) in a single surgical unit. METHODS: This is a retrospective analysis of health records of the male patients who underwent surgery for IH at a single surgical center, during the period May 1, 2015–May 1, 2016, where the surgeons adhered to “guideline-based treatment for IH.” Health records of the patients who underwent surgery for IH from May 1, 2014, to April 30, 2015, too were collected for comparison. Data related to demographics, surgical approach, mode of anesthesia, and surgical complication were analyzed. RESULTS: Sixty-two male patients with a mean age of 33.5 (range: 22–54) years and 99 male patients with a mean age of 32.84 (range: 22–70) years have undergone IH repair before the IHP and during the IHP, respectively. The overall use of local anesthesia (LA) for unilateral IH had increased from 3.5% (n = 2) to 83.12% (n = 65) (P ≤ 0.0001) during IHP. The laparoscopic approach was used in 83.34% of patients with bilateral IH during IHP (P = 0.0007). All (n = 3) the recurrences following open repair were attempted to treat laparoscopically during the IHP. Laparoscopic approach was not utilized to treat IH before the IHP. Overall recurrence rate increased to 4.04 (n = 4) during IHP from 0% (P = 0.299). Overall complication rate increased from 3.22% (n = 2) to 8.08% (n = 8) during IHP (P = 0.319). CONCLUSION: Surgical approach and mode of anesthesia for IH treatment showed high conformity with the guidelines during the IHP. The increased recurrence and complication rates were statistically insignificant.

Local anesthesia underutilized for inguinal hernia repair in northern Ghana.

IntroductionInguinal hernia repair is a common procedure and a priority for public health efforts in Ghana. It is essential that inguinal hernia repair be performed in a safe, efficient manner to justify its widespread use. Local anesthesia has many favorable properties and has been shown to be superior, compared to regional or general anesthesia, in terms of pain control, safety profile, cost-effectiveness, resources required, and time to discharge. Local anesthesia is recommended for open repair of reducible hernias, provided clinician experience, by multiple international guidelines. Regional anesthesia is associated with myocardial infarction and other complications, and its use is discouraged by multiple guidelines, especially in older patients. This study aims to assess the current state of anesthesia for inguinal hernia repair in the northern and transitional zone of Ghana. In addition we will assess the perceptions of different types of anesthesia along with understanding of evidence-based guidelines among clinicians participating in inguinal hernia repair.MethodsWe performed a retrospective review of all inguinal hernia repairs for male patients, 18 and older, in over 90% of hospitals in northern Ghana. All 41 hospitals were visited and caselogs and patient charts were manually reviewed to extract data. Multivariate logistic regression was used to determine predictors of local anesthesia use. We designed a survey instrument to assess the perceptions of physicians and anesthetists regarding different types of anesthesia for inguinal hernia repair. The survey was designed by a Ghanaian surgeon, reviewed by all co-authors, and tested prior to implementation using a sample (n = 8) of clinicians having similar practices to those of the survey population. Of 70 clinicians, 66 responded, yielding a response rate of 94%.Results8080 patients underwent hernia repair of which 37% were performed under local anesthesia, while the majority, 60%, were performed under regional anesthesia. Negative predictors of local anesthesia were emergent repair (OR = 0.258, p < 0.001), surgery performed at a teaching hospital (OR = 0.105, p < 0.001), and bilateral hernia repair (OR = 0.374, p < 0.001). 1,839 (22.8%) of IH repairs were done on patients age 65 or older and RA was most frequently used among the elderly population (57.8%), while local anesthesia was used 39.5% of the time. Sixty-six clinicians participated in the survey with the majority reporting that local anesthesia requires fewer staff, less equipment, has a shorter recovery, is more cost-effective, and might be safer for patients. However 66% were unfamiliar with or incorrectly perceived international guidelines.ConclusionTo our knowledge, this study is the largest assessment of anesthesia use for inguinal hernia repair in an LMIC. Although the selection of anesthetic technique should be guided by a patient’s general health, the anatomy of the hernia, and clinician judgment, local anesthesia appears to be underutilized in northern Ghana. Survey responses demonstrate high rates of unfamiliarity or incorrectly perceived evidence-based guidelines. Future research should assess how education on the benefits and technique of local anesthesia administration may further increase rates for inguinal hernia repair, especially for older patients.

Paravertebral block versus unilateral spinal anesthesia for inguinal hernia repair - A comparative clinical trial

Paravertebral block versus unilateral spinal anesthesia for inguinal hernia repair - A comparative clinical trial

Protective multimodal analgesia with etoricoxib and spinal anesthesia in inguinal hernia repair: a randomized controlled trial.

Inguinal hernia repair is a common procedure, and can be performed under spinal anesthesia. Although adequate analgesia is crucial to postoperative recovery, the optimal protective analgesic regimen remains to be established. To investigate the effects of preoperative etoricoxib within a protective multimodal analgesic regimen with respect to pain control following open inguinal hernia repair. Sixty adult patients undergoing open inguinal hernia repair participated in a single-center, randomized, double-blinded, placebo-controlled trial in a general academic medical center. The intervention group (n=30) received 120mg of oral etoricoxib 1h preoperatively, and 10-12mg bupivacaine with 25μg fentanyl as spinal anesthesia. The control group (n=30) received oral placebo 1h preoperatively, and spinal anesthesia as above. Postoperative Visual Analog Scale pain scores at rest and on active straight leg raise were recorded and analyzed. Resting pain scores were significantly lower in the intervention than the control group at 16h, 24h, and on discharge (3.00 vs. 4.35; 1.57 vs. 4.00; 1.24 vs. 3.76, respectively; p<0.05). Pain scores on active straight leg raise were significantly lower in the intervention than the control group at 16h, 24h, and on discharge (3.85 vs. 5.59, p<0.01; 2.84 vs. 4.90, p<0.05; 3.55 vs. 5.32, p<0.05, respectively). The addition of etoricoxib to spinal anesthesia as a multimodal protective regimen can improve pain control after inguinal hernia repair. The optimal dose and applicability to other operations remains to be established.

A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants.

Recent concerns regarding possible long-term effects of early anesthesia exposure on neurodevelopment in children have provided an impetus to explore alternative anesthetic techniques using potentially neuroprotective agents. Dexmedetomidine has not been implicated in anesthesia-induced neurotoxicity and has been shown to be neuroprotective in preclinical studies. We describe a case series of 50 neonates and infants who received dexmedetomidine sedation with caudal anesthesia instead of general endotracheal anesthesia for inguinal hernia surgery. We conducted a retrospective chart review on all neonates and infants who underwent inguinal hernia surgery with dexemetomidine sedation and caudal anesthesia in our institution. We started exploring this technique since October 2011 and established a protocol of administering dexmedetomidine 2 mcg·kg(-1) over 10 min, followed by 1 mcg·kg(-1) over the next 10 min. This led to satisfactory conditions for caudal placement in 20 min, with minimal need for airway intervention during surgery. The median gestational age of the infants was 31.4 (28.7, 36.0) weeks and median postconceptual age was 39.7 weeks (IQR 37.8, 45.7) at time of surgery. Of patients, 86% had surgery successfully completed under this technique alone. Seven patients required sevoflurane or nitrous oxide due to failed caudal block (n = 1) or difficult or prolonged surgery (n = 6). After establishing the sedation protocol and excluding patients with large or complicated hernias, the success rate was 96%. Transient intra-operative apnea or hypoventilation occurred in five patients and postoperative apnea in two patients. All respiratory events were easily reversed and no patient developed significant bradycardia or required intubation. Dexmedetomidine sedation with caudal anesthesia is a feasible alternative to spinal or general anesthesia in selected infants undergoing uncomplicated hernia surgery. It avoids the need for endotracheal intubation and may be potentially beneficial in avoiding the unknown effects of general anesthesia on neurodevelopment.

English

We present a novel technique for securing an endotracheal tube after using a #1 Classic laryngeal mask airway (LMA) as a conduit for intubating the trachea of a premature infant. During induction of anesthesia for inguinal hernia repair in an ex- 23-week infant, an unanticipated difficult airway was encountered. After several unsuccessful attempts of intubating via direct laryngoscopy, we placed the endotracheal tube (ETT) into the trachea using a fiberoptic bronchoscope through a #1 LMA. A pediatric stylette, with Hytape TM wrapped around the distal tip, was then used as a plunger to safely and easily remove the LMA from the mouth while maintaining the ETT in proper position. This technique is applicable in cases of a difficult neonatal airway where even a #1, the smallest LMA, is used.

The comparative evaluation of safety and efficacy of unilateral paravertebral block with conventional spinal anaesthesia for inguinal hernia repair.

Background and Aims:Unilateral paravertebral block (PVB) as a sole anaesthetic technique is underutilised even in experienced hands. Hence, this study was undertaken regarding the efficacy and safety of PVB and compared with subarachnoid block (SAB) for inguinal hernia repair procedures.Methods:Sixty-three consenting adult male patients scheduled for unilateral inguinal hernia repair were randomly assigned to receive either PVB or SAB (Group P: PVBs at T10–L2 levels, 5 mL of 0.5% bupivacaine at each segment; Group S: SAB at L3–L4 level with 12.5 mg 0.5% of hyperbaric bupivacaine). Primary objective was to compare duration of post-operative analgesia and time to reach discharge criteria (modified Aldrete scores and modified post-anaesthetic discharge scoring [PADS] scores). Secondary objectives were to compare the block characteristics (time required for performing the block, time to surgical anaesthesia, time to ambulation, time to the first analgesic, total rescue analgesic consumption) and adverse effects. Independent Student's t-test was used for continuous data and Pearson Chi-square test for categorical data. P <0.05 was considered as statistically significant.Results:The duration of post-operative analgesia (min) was 384.57 ± 38.67 in Group P and 194.27 ± 20.30 in Group S (P < 0.05). Modified PADS scores were significantly higher at 4 h and 6 h (P < 0.0001) in Group P. Time to reach the discharge criteria was early in Group P than Group S.Conclusion:PVB provides excellent post-operative analgesic conditions with lesser adverse effects and shorter time to reach the discharge criteria compared to SAB.