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

Abstract

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.

Outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation

“…18 Similarly, it has been recently demonstrated that MV procedures utilizing a subinguinal approach can be safely and effectively performed under multimodal LA alone, with post-operative patient tolerability remaining trivial. 4 Our study furthered these findings by demonstrating peri-operative tolerability in patients undergoing an MV under multimodal LA, which in part may be attributed to the DIVS used in our approach. Additionally, this study was able to successfully build upon findings in prior work by increasing the sample size in the inguinal cohort and demonstrating a variety of procedures utilizing subinguinal approaches.…”

“…1,2 Traditionally, these approaches are thought to necessitate general (GA) or spinal anesthesia (SA), with the choice of anesthetic being driven largely by safety, feasibility, and patient comfort. 3,4 However, given the severe surgical backlog which has only further accumulated following the COVID-19 pandemic, it has become increasingly difficult to complete cases requiring a hospital operating room (OR) in a timely fashion. 5 Deep intravenous sedation (DIVS) in conjunction with local anesthetic (LA) is an alternative choice of anesthetic which can be utilized in the ambulatory surgical setting.…”

Local Anesthesia During Operations on the Cervix, Vagina, and Vulva

“…Существует множество вариантов описания применения инфильтративной анестезии при проведении операций у животных [25][26][27]. Зарубежные источники разных лет содержат информацию о сравнении местной и общей анестезии при проведении гистероскопии, мануальной вакуумной аспирации полости матки, биопсии тканей репродуктивных органов и даже лапароскопии [10,[28][29][30][31][32][33][34][35][36][37][38]. Безусловно, в работах, посвященных применению местной анестезии при лапароскопии, описана эффективность комбинированных методов обезболивания -по данным М. Сугихара и др.…”

Scrotal Pain after Varicocelectomy: A Narrative Review

“…Varicocele is a frequently diagnosed urological condition [ 1 , 2 , 3 ], affecting approximately 8 to 15% of healthy men [ 4 , 5 ]. The incidence of varicocele varies among different age groups.…”