Local Anesthesia in Open Inguinal Hernia Repair Improves Postoperative Quality of Life Compared to General Anesthesia: A Prospective, International Study

摘要

The choice of general (GA) versus local anesthesia (LA) in open inguinal hernia repair (OIHR) has a substantial financial impact and may influence clinical outcomes. Our study compares postoperative quality of life (QOL) in patients undergoing OIHR under LA versus GA. A cooperative prospective study from centers in 10 countries was performed through the International Hernia Mesh Registry from 2007 to 2012. QOL was compared at one, six, 12, and 24 months for LA versus GA with univariate and multivariate analysis controlling for known confounding variables. Of 1128 patients who underwent OIHR, 585(52%) used GA and 533(48%) used LA. Most were male (92%) with unilateral (94%), primary (91%) repairs with a mean age 57 6 16 years. There was no difference (P > 0.05) in age, gender, operative time, mesh size, length of stay, infection, recurrence, reoperation, or death. Multivariate analysis demonstrated significant QOL differences between groups: GA had higher odds of discomfort at one and six months [odds ratio (OR) 3.3, 2.0], movement limitation at one and six months (OR 3.5,2.8), and mesh sensation at one and 12 months (OR 2.9,1.8). Overall, patients undergoing OIHR under LA had improved postoperative QOL in the short and long term compared with GA. The clinical comparison of anesthetic effect on inguinal hernia repair dates back to the 1900s when Harvey Cushing extolled the advantages of local anesthesia (LA) over general anesthesia (GA), "There is avoidance of the unpleasant or dangerous post-etherization sequelae. There is no vomiting or retching to put strain on recent sutures. Urinary disturbances are less apt to occur, and catheterization is rarely necessary. The diet continues as before the operation. [.] Above all is the advantage gained in being able to operate with comparative safety in patients who would incur immediate risk submitting to general anesthesia."