Local or Spinal Anesthesia in Subinguinal Varicocelectomy: A Prospective Randomized Trial

Kadıhasanoğlu, Mustafa; Karagüzel, Ersagun; Kaçar, Cem Kıvılcım; Arıkan, Mehmet Salih; Yapıcı, Mustafa Engin; Türkmen, Nihat

doi:10.1016/j.urology.2012.01.052

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…The spinal group developed more postoperative complications, such as urinary retention, postspinal backache, headache, hypotension, and delayed mobilization. In line with our findings they concluded that local anesthesia is an effective, simple, and safe approach for subinguinal varicocelectomy with lower morbidity and fast recovery (17). Likewise, Manaf et al compared local and general anesthesia in patients who had undergone different andrological procedures including varicocelectomy.…”

Section: Discussionsupporting

confidence: 85%

Feasibility of local anaesthesia for varicocele correction in one-day-surgery setting. A single center experience

Saredi

Scroppo

Capogrosso

et al. 2021

Arch Ital Urol Androl

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Objective: In this study, we compared postoperative outcomes of patients submitted to varicocele correction under general or local anesthesia at a single center. Methods: All patients underwent varicocele surgical treatment with the Colpi-modified Marmar subinguinal technique. They were managed with either general (Group A) or local with ileo-inguinal and ileo-hypogastric nerves block (Group B) anesthesia. The two groups were compared in terms of timing of discharge and post-operative pain as assessed with the numeric rating scale (NRS) at both rest and movement (NRSm). §Results: Overall, 63 patients were included with a mean (SD) age of 25 years ± 5 yrs. The NRS mean score was significantly lower for Group B during the first 4 days after surgery at both rest and movement (all p < 0.05). Patients receiving local anesthesia showed a faster time to first urination (210 vs. 240 min; p = 0.02), although the time to discharge was comparable between the two groups (250 vs. 250 min). Conclusions: These results suggest that local anetshesia for varicocele surgical treatment is feasible and provide better pain control and faster recovery after surgery.

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Section: Discussionsupporting

confidence: 85%

Feasibility of local anaesthesia for varicocele correction in one-day-surgery setting. A single center experience

Saredi

Scroppo

Capogrosso

et al. 2021

Arch Ital Urol Androl

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“…Type I error α was 0.05, type II error β was 0.10 [power (1 − β) = 0.90], the 2-tailed p value was <0.05, the study and control group ratio was 2:1, and at least 184 patients in the LA group and 92 patients in the GA or SA group were included, respectively. It was calculated by the PASS 11.0 (Power Analysis and Sample Size 11.0, NCSS Inc., Kaysville, UT, USA) [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…The preferred anesthesia technique depends on several factors, including the procedure’s suitability for the patient, surgeon choice, patient acceptance, safety, perioperative pain control, the time to return to normal activity, the need for monitoring, and cost-effectiveness. LA is associated with reduced pain, decreased postoperative analgesic requirement, less need for postoperative care, lowered postoperative nausea and vomiting complications, a short anesthesia time and a short hospital stay, compared with GA [ 10 , 11 ]. Although many studies have compared LA and SA or GA for hernia repair, limited studies have compared them for varicocelectomy, and it is not clear whether LA is a suitable alternative to SA or GA for the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Prospective Comparison of Local Anesthesia with General or Spinal Anesthesia in Patients Treated with Microscopic Varicocelectomy

Wang

Pan

et al. 2022

JCM

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It is unclear whether local anesthesia (LA) is a viable and safe alternative to general anesthesia (GA) or spinal anesthesia (SA) for microscopic varicocelectomy. As a result, we designed a prospective trial to compare the pain relief, complications, and cost of LA with GA or SA in subinguinal microscopic varicocelectomy (MSV), using the propensity score matching method (PSM). This prospective study was conducted in a tertiary hospital from February 2021 to April 2022. Patients who underwent subinguinal MSV for varicocele were enrolled. The perioperative visual analog scale (VAS) scores, anesthesia-associated side effects, and cost data were recorded, and PSM analysis was performed. Finally, 354 patients were included, of whom 61.0% (216) were treated with LA, and 39.0% (138) underwent GA or LA. After PSM, the patients in the LA group exhibited lower VAS scores both three hours and one day after surgery, and a lower incidence of postoperative analgesic requirement; a lower ratio of patients who experienced anesthesia-associated side effects was also observed in the LA group, compared with the GA or SA group (all p < 0.001). The rate of perioperative satisfaction for patients was higher, the hospital stays and days to return to normal activity were shorter, and the cost was less in the LA group than in the patients in the GA or SA group (all p < 0.001). This prospective PSM cohort demonstrated that LA has the advantages of perioperative pain relief, reduced anesthesia-associated side effects, and cost, compared with GA or SA. It indicated that LA is an effective and safe technique for subinguinal MSV, and may guide clinical practice.

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“…Unfortunately, many of the studies [30][31][32][33][34][35] which compared spinal anesthesia with other techniques came along with various drawbacks (exact spinal technique not described, problems with blinding, incomplete data presentation), and their results are often difficult to generalize to other clinical settings. For example, in an otherwise commendable, epidemiological study of anesthetic techniques for inguinal hernia repair in Spain [30], spinal anesthesia was used more often (n ¼ 143) than general anesthesia (n ¼ 65) and local anesthesia with sedation (n ¼ 30) but was associated with higher POUR rates and longer discharge times.…”

Section: Spinal Versus Other Anesthetic Techniquesmentioning

confidence: 99%

Short-acting spinal anesthesia in the ambulatory setting

Förster

2014

Current Opinion in Anaesthesiology

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Intrathecal articaine (off-label use for the time being), chloroprocaine, and prilocaine (the latter two officially approval in several European countries) remain a very appealing option in the ambulatory setting. Chloroprocaine may have a slight edge as regards ultra-short and short surgery, whereas articaine and prilocaine may suit well for somewhat longer procedures. Future follow-up investigations should establish possible differences between these local anesthetics, also with respect to other anesthetic techniques and to economical aspects.

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Local or Spinal Anesthesia in Subinguinal Varicocelectomy: A Prospective Randomized Trial

Cited by 13 publications

References 20 publications

Feasibility of local anaesthesia for varicocele correction in one-day-surgery setting. A single center experience

Feasibility of local anaesthesia for varicocele correction in one-day-surgery setting. A single center experience

Prospective Comparison of Local Anesthesia with General or Spinal Anesthesia in Patients Treated with Microscopic Varicocelectomy

Short-acting spinal anesthesia in the ambulatory setting

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