[Comparative studies of total extraperitoneal hernioplasty in combined spinal epidural anesthesia versus balanced...

To appraise the clinical impact of combined spinal-epidural anaesthesia (CSE) in patients undergoing total extraperitoneal laparoscopic hernia repair (TEPP), we performed a prospective study in 40 patients. These patients were randomized to receive either CSE (n = 20) or a balanced general anaesthesia (BGA) with controlled ventilation (n = 20). The aim of the study was to determine the impact of the intraoperative gas insufflation on compensatory respiratory reactions during regional anaesthesia. Therefore, blood gas samples were drawn and additional parameters were assessed as follows: noninvasive haemodynamic, lactate and glucose levels, differential blood count, and the patients' level of comfort during the perioperative setting, which was determined by a questionnaire. In our study it was clarified that the respiratory compensation of extraperitoneal gas insufflation is not decreased by regional anaesthesia. The haemodynamic state of the patients was stabilized by early interventions. In addition--there was no evidence that the anaesthesia regime used had any influence on the so called stress-parameters. Most of the patients with regional anaesthesia showed severe agitation often accompanied by chest pain. Hence, regional anaesthesia is not recommended in this setting.