Open inguinal hernioplasty under local, spinal and general anaesthesia: a comparative study

Area of Science:

• Surgical Anesthesiology
• Hernia Surgery Outcomes
• Patient Recovery Metrics

Background:

• Inguinal hernia repair is a common general surgery procedure, with anesthesia choice impacting patient outcomes.
• While specialized centers use local anesthesia, spinal and general anesthesia remain prevalent for open inguinal hernia repair.
• This study compares short-term outcomes of open inguinal hernia mesh repair under local, spinal, and general anesthesia.

Purpose of the Study:

• To compare post-operative pain scores across local, spinal, and general anesthesia groups.
• To evaluate surgical duration, analgesia duration, activity resumption, diet initiation, and voiding times.
• To assess complications, quality of life (EuroQol), and patient satisfaction with anesthesia choice.

Main Methods:

• A prospective, observational study of 135 patients undergoing open inguinal hernioplasty (Lichtenstein technique).
• Patients were divided into three groups: local anesthesia (LA), spinal anesthesia (SA), and general anesthesia (GA) (45 patients each).
• Short-term outcomes including pain scores, recovery metrics, complications, quality of life, and satisfaction were recorded and analyzed.

Main Results:

• Lower post-operative pain scores were observed in the LA group compared to SA and GA groups from post-operative day 1 to 6 (p < 0.001).
• The LA group showed significantly better outcomes in duration of analgesia, return to walking, meal initiation, and hospital discharge (p < 0.001).
• Results favored LA regarding nausea, vomiting, analgesic use, and urinary retention, with no significant difference in overall satisfaction or quality of life.

Conclusions:

• Local anesthesia is well-tolerated for open inguinal hernia repair, offering significantly lower immediate post-operative pain and reduced analgesic requirements.
• Patients under LA experience faster resumption of basic activities (walking, voiding, diet) with no urinary retention, avoiding risks of other anesthesia types.
• Local anesthesia leads to shorter surgery and hospital stays, enabling daycare procedures with comparable quality of life and patient satisfaction.