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

Abstract

Background: Inguinal 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. Methods: Eligible 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. Results: Six 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. Conclusions: SA 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.

Prophylactic Administration of Alpha Blocker for the Prevention of Urinary Retention in Males Undergoing Inguinal Hernia Repair Under Spinal Anesthesia: Interim Analysis of a Randomized Controlled Trial

“…The latter has been also confirmed in a previous study from our group, where 32% of patients under spinal anesthesia developed POUR [4]. However, despite these, spinal anesthesia, still, remains an attractive option for IH repair [5], since regional anesthesia is associated with favorable results in terms of hypotension, postoperative nausea, vomiting, and pain [3,6].…”

The Differences of Pain Characteristics Among Post-Surgery Clients with General and Regional Anesthesia

“…Luo's (2017) research states that 41% of patients who are in the recovery room experience pain ranging from moderate to severe (Luo & Min, 2017). Li's research results explain that the effect of pain caused by regional anesthesia is better than general anesthesia (Li et al, 2020).…”

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

“…Inguinal hernia (IH) is a common disease among all age groups that requires surgery: 27%-42% of affected male and 3%-6% of affected female patients [1,2]. IH has a high prevalence in the older population (≥65 years), which can be attributed to multiple factors, including abdominal wall weakness, benign prostatic hyperplasia, chronic cough, and chronic constipation, all of which are common in this age group [1][2][3][4]. The cumulative probability of pain and irreducibility increases with time (pain 90% and irreducibility 30% at 10 years) [5].…”

“…The cumulative probability of pain and irreducibility increases with time (pain 90% and irreducibility 30% at 10 years) [5]. Elective IH repair is considered a safe and low-risk surgery and has a valuable role in preventing hernia-related complications [1,3]. However, older patients are occasionally approached conservatively and denied surgery because of their functional status and the presence of comorbidities [1,4,[6][7][8].…”