Comparison of local and spinal anesthesia techniques in inguinal hernia repair

The aim of this study is to evaluate the safety and effectiveness of local anesthesia in surgical treatment of inguinal hernia, compared with spinal anesthesia. Ninety-six patients who underwent hernia repair between December 1999 and April 2002 were included prospectively. The patients were assigned randomly to two groups according to their admission numbers. Group I included 47 patients undergoing surgical treatment of inguinal hernia with local anesthesia; Group II included 49 patients having inguinal hernia repair with spinal anesthesia. The early complication rates, length of the hospital stay, and costs were evaluated prospectively. Early complication rates were 14.8 and 32.6%, respectively; there was no significant difference between the two groups. The length of hospital stay and cost were significantly lower in Group I than in Group II. In conclusion, local anesthesia is a safe and cost-effective method in the treatment of inguinal hernia.     

局麻腹膜前间隙修补术在老年腹股沟疝的治疗进展

腹股沟疝在老年患者中有较高的发病率,由于老年人常合并有循环系统、呼吸系统疾病,在手术术式、麻醉的选择时需要更加谨慎,更有针对性,需要实施个体化治疗。本文将回顾腹股沟疝手术的发展简史,探讨各种腹股沟疝手术的发展历程,并着重讲述局麻下腹膜前间隙疝修补术的各种代表术式在老年腹股沟疝的治疗研究进展。笔者所在科室近10年开展局麻下腹膜前间隙疝修补术已有五百多例,积累了较多的临床经验,现结合国内外文献报道及自身手术经验,对局麻腹膜前间隙修补术在老年腹股沟疝的治疗进展做一综述。     

腹股沟疝修补方式的个体化选择（附1140例分析）

目的总结我院开展局麻下个体化腹股沟疝修补手术的经验,探讨进一步提高腹股沟疝治疗总体疗效的方法。方法对我院2004年8月至2009年6月间进行局部麻醉下个体化腹股沟疝修补手术1140例患者的临床资料进行分析。结果局麻下个体化腹股沟疝修补术患者平均住院（2．3±1．1）d,术后出现并发症77例侧,手术后随访18～60个月,复发5例,出现异物感和慢性疼痛18例。结论根据腹股沟疝分型进行局麻下个体化腹股沟疝修补手术针对性强,手术简单易行,并发症少,疗效可靠,是值得推广的腹股沟疝修补手术方式。     

Hernia repair and local anesthesia. Results of a controlled randomized clinical trial

In the past, general and spinal anesthesia were used for hernia surgery, but nowadays local anesthesia has become the method of choice for hernia repair, especially in outpatient patients. The one-day surgery is sufficient in the management of this pathology. The advantages of local anesthesia are simplicity, safety, extended postoperative analgesia, early mobilization, lack post-anesthesia effects, and low costs. From January 2004 to December 2008 we observed 297 male patients with inguinal hernia. These patients were divided, with rigorous chronological order of hospital admission, in two study groups, different for anesthetic techniques used. Our controlled randomized clinical trial examines the effectiveness of local anesthesia to reduce the time of hospitalization, without alteration of results, and particularly the degree of satisfaction of patients surgical treated for inguinal hernia.     

78例老年性腹股沟嵌顿性疝的治疗研究

目的探讨局麻下行无张力疝修补术治疗老年性腹股沟嵌顿性疝的治疗效果。方法对笔者所在医院外科2006年3月～2010年3月收治的老年性腹股沟嵌顿性疝78例患者的临床资料进行同顾性分析。结果78例患者手术全部成功,手术时间40-50min,切口无明显疼痛,术后下床活动时间2～12h,1周恢复正常活动。并发症：伤口硬结3例,阴囊积液1例。随访1—5年无复发病例。结论局麻下行无张力疝修补术治疗老年性腹股沟嵌顿疝是一种安全、有效的术式。     

腹股沟疝手术局部麻醉方法探讨

目的 介绍一种腹股沟疝手术局部麻醉方法.方法 2005年至2006年5月,对450例腹股沟疝患者行局部麻醉下日间手术治疗.结果 450例腹股沟疝患者在局部麻醉下手术均成功,无手术并发症发生.结论 局部麻醉是成年人行可复性腹股沟疝手术最好的麻醉选择.这种方法有安全、简便、有效和经济的特点,无麻醉后不良返应.     

局麻下疝修补术在老年腹股沟疝中的应用策略

目的探讨局麻下疝修补术在老年腹股沟疝中的应用。方法回顾性分析我科2003年至2007年在局麻下行疝修补术的143例老年腹股沟疝患者的临床资料。结果对于合并各种疾病的老年腹股沟疝患者,局麻的镇痛效果良好,对患者的干扰小,扩大了手术适应证,使用合适大小的补片代替或修复腹横筋膜的腹膜前间隙疝修补疗效确切、符合生理、痛苦小、并发症少,本组患者均痊愈出院,随访至今无复发。结论对于合并各种疾病的老年腹股沟疝患者,局麻下腹膜前间隙疝修补具有不可替代的优势。     

Local anesthesia in the treatment of inguinal hernia

Local anesthesia is the most common technique used in the surgical treatment of inguinal hernia. The introduction of synthetic prosthesis, which are resistant to infection, has to the development of surgical techniques used in local anesthesia, in a day hospital setting. These techniques permit a lowering of hospital costs and a reduction of the incidence of complications and recurrences. Over the last few years the authors have been performing a modified Lichtenstein repair or the Rives technique in local anesthesia. In this study they present their data on 52 patients surgically treated in the period 1997-1998, and discuss the advantages of their technique.     

Elimination of urinary retention following inguinal herniorrhaphy

In a group of 880 patients undergoing inguinal herniorrhaphy using local anesthesia, the incidence of postoperative urinary retention was 0.2 per cent. During the same period, a similar group of 200 patients had their hernias repaired using general or spinal anesthesia. The incidence of postoperative urinary retention was 13 per cent. The authors contend that the use of local anesthesia in inguinal hernia repair almost eliminates postoperative urinary retention.     

腹腔镜下完全腹膜外疝修补术治疗老年单侧腹股沟疝的随机对照研究

目的研究腹腔镜下完全腹膜外疝修补术治疗老年单侧腹股沟疝的临床效果。方法研究对象为北京大学深圳医院2015年10月到2017年7月单侧腹股沟疝患者120例,根据手术治疗方法不同随机分为对照组与观察组各60例。对照组采用局麻下开放式腹股沟疝无张力修补术(OTFHULA);观察组采用腹腔镜下完全腹膜外腹股沟疝无张力修补术(TEP)。比较不同手术方式患者手术时间、术中出血量、总住院费用、术后恢复正常活动时间、术后第1天疼痛数字评分(NRS)、术后近期并发症发生率、术后远期并发症发生率。结果手术时间、术中出血量、总住院费用观察组大于对照组(P均0.001);术后恢复正常活动时间、术后第1天疼痛数字评分观察组小于对照组(P0.05)。术后近期并发症发生率、术后远期并发症发生率与对照组差异无统计学意义。结论对于老年单侧腹股沟疝患者,OPFHULA组和TEP组治疗均有各自优缺点,临床可根据患者的实际情况及术者对术式的熟练程度合理选择手术方式。     

The role of antibiotic prophylaxis on wound infection after mesh hernia repair under local anesthesia on an ambulatory basis

Mesh prosthesis, local anesthesia, and ambulatory care have been widely introduced in recent decades in the treatment of inguinal hernia. The use of antibiotic prophylaxis during open inguinal hernia repair has been controversial. No prospective trial has been conducted to assess the role of antibiotic prophylaxis in patients operated on for inguinal hernia under the above-mentioned conditions. A prospective, randomized, double-blinded trial was initiated to assess the efficacy of antibiotic prophylaxis in the prevention of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis. Ninety-nine consecutive hernia repairs were randomized to receive 1 g of parenteral Cefazolin preoperatively or a placebo. No wound infections existed in the therapeutic group (0/50). Four infections appeared in the control group (4/49), and the study was suspended for ethical reasons when differences reached values close to statistical significance (P=0.059). We conclude that a single dose of intravenous Cefazolin decreases the risk of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis.     

局部神经阻滞麻醉下腹股沟疝无张力修补术围手术期晕厥22例

目的：探讨局部区域神经阻滞麻醉下腹股沟疝围手术期内晕厥的原因和对策。方法回顾性分析2011年3月至2013年8月,河南省巩义市人民医院对进行379例腹股沟疝患者围手术期发生晕厥的22例患者行及时对症处理和原因分析。结果17例患者在3 min内渐恢复,5例患者脉搏＜45次/min,给予阿托品针0．5 mg静脉注射,5 min后渐恢复。间隔30 min监测生命体征1次至正常。恢复后均无精神、神经系统症状,其中4例因摔伤行皮肤清创缝合,3例推迟手术时间。患者无神经系统、心血管系统后遗症。结论麻醉药品、手术方式不是引起局部神经阻滞麻醉腹股沟疝围手术期出现晕厥的直接原因,围手术期内良好的医患沟通、对患者机体综合评估、充分的围手术期准备可预防和减少晕厥发生。     

局部神经阻滞麻醉下腹膜前无张力疝修补术治疗高龄腹股沟疝110例

目的：探讨局部神经阻滞麻醉下的腹膜前腹股沟无张力疝修补的应用。方法回顾性分析2012年1月至2013年12月,上海市第六人民医院收治的高龄腹股沟疝患者110例,行局部神阻滞麻醉下的腹膜前无张力疝修补。观察手术时间、住院时间、术后并发症。结果本组患者手术时间35-60 min,平均（45±5）min;住院时间2-3 d。术后出现尿潴留3例,阴囊浆液肿8例,慢性疼痛5例,无切口感染发生,随访4-12个月,无复发,无死亡患者。结论局部神经阻滞麻醉下的腹膜前无张力疝修补术是治疗高龄腹股沟疝患者较为理想的术式,临床治疗效果满意。     

Patientenerwartungen vor elektiver Leistenhernienoperation

Introduction

The pressure to save costs will lead to an increased use of outpatient facilities for inguinal hernia repair. Little is known about patients’ expectations concerning inguinal hernia repair and the implication for ambulatory surgery.

Methods

In a prospective study, 156 patients with unilateral hernia were questioned about their expectations concerning the upcoming surgery. They were asked to evaluate different aspects using a visual analogue scale, to answer questions in an essay style, and to name the five most important aspects of surgery.

Results

The five most important aspects were recurrence rate, personal contact with the physician, postoperative pain management, recovery time, and the medical facilities. The possibility for outpatient surgery and for local anesthesia seemed to be most important to young, professionally active patients (<30 years), whereas older patients were more concerned about insufficient postoperative recovery at home and surgical complications.

Conclusions

If patients’ expectations are considered, outpatient inguinal hernia repair will favor surgical techniques under local anesthesia with mesh implantation. Postoperative patient care will have to include intensified patient information, adequate pain management, and well-organized home recovery.     

应用局麻无张力疝修补术治疗复发性腹股沟疝34例

目的通过手术所见分析腹股沟疝术后复发的病因，总结局麻无张力疝修补术治疗复发性腹股沟疝的临床经验。方法回顾性分析和总结2006年1月至2008年1月收治复发性腹股沟疝患者34例（经典疝修补术后复发疝患者32例，其中Bassini13例，Ferguson9例，Halsted7例，Schouldice3例；无张力疝修补术后复发2例）行局麻无张力疝修补的临床资料。结果全组均治愈出院，术后阴囊水肿4例，阴囊血肿1例，随访6个月-2年无复发病例。结论要达到理想的复发疝修补效果和低复发率，应充分考虑复发的病因，术中进行分析，合理选择修补材料和个体化手术方法，规范技术操作，应用局麻无张力疝修补术是一种理想术式。     

局部麻醉和硬膜外麻醉在腹股沟疝无张力修补术中的对照研究

目的 探讨局部麻醉和硬膜外麻醉下行腹股沟疝修补术的疗效与安全性. 方法 2004年1月至2006年12月我院收治的269例腹股沟疝患者,按数字表法随机分为两组,143例采用局部浸润麻醉,126例采用硬膜外麻醉,比较分析两组临床资料. 结果 局部麻醉组在手术(加麻醉)时间、下床时间、住院天数及费用方面均明显少于硬膜外麻醉组(P<0.05),在术中静脉镇静药物使用、术后疼痛程度、恢复日常生活时间上差异无统计学意义(P>0.05).两组患者的伤口及阴囊并发症发生率差异无统计学意义(P>0.05).硬膜外麻醉组术中平均动脉压下降,术后恶心、呕吐、尿潴留发生率显著高于局部麻醉组(P<0.05).两组在随访期内各有1例疝复发(P>0.05). 结论 局部麻醉下行腹股沟疝修补手术简单、安全、经济、可靠,是更为理想的麻醉方式.     

局麻下善愈补片在腹股沟疝无张力修补术中的应用

目的探讨局麻下善愈补片在腹股沟疝修补术中的应用经验。方法回顾性分析并随访我院近4年来在局麻下施行的善愈补片无张力腹股沟疝修补术104例(114侧),对患者手术前合并症、手术时间、手术方式、术后并发症以及术后住院天数进行综合分析。结果本组患者手术过程顺利,麻醉效果好,术后疼痛耐受好,不需常规应用镇痛药物,并发症少,手术时间平均45min(30～60min),术后住院天数3～7d,术后随访6～24个月无复发。结论局麻下应用善愈补片实施腹股沟疝无张力修补术可行性好,该术式具有简单、安全、并发症少、术后恢复快、费用低等优点,适合于成人各种腹股沟疝的治疗。     

局部麻醉下腹股沟疝无张力修补术临床路径及其应用

目的：探讨局部麻醉下腹股沟疝无张力修补术的临床路径及其应用。方法观察局部麻醉下腹股沟疝无张力修补术临床路径的56例患者住院时间、住院各项费用及并发症情况。结果进入临床路径56例患者中,54例完成临床路径,2例退出,完成率为96．4％;纳入临床路径的患者住院时间明显缩短,各项费用显著降低;有14例患者出现术后近期并发症,无复发。结论局部麻醉下腹股沟疝无张力修补术临床路径操作简单,能明显缩短住院时间、降低住院医疗成本,减轻患者和社会负担,值得推广。     

腹股沟疝无张力修补术1251例临床分析

目的分析腹股沟疝无张力修补术的手术方法及治疗效果。方法回顾分析我院2002年1月至2008年3月收治的1251例腹股沟疝无张力修补术患者的临床资料。结果1251例患者成功施行无张力疝修补术,使用局麻1230例,全麻21例。所采用术式包括平片修补法、Meshplug法和腹膜前间隙修补法。术后出现尿潴留19例,浆液肿47例,阴囊血肿24例,伤口异物感3例,伤口感染3例,随访1个月至6年有2例复发。结论掌握局麻技术,应用个体化治疗方案选择无张力疝修补术式和材料,尤其是熟练掌握腹膜前间隙修补的手术方法,将使腹股沟疝患者的临床治疗获得非常好的疗效。     

Current options in local anesthesia for groin hernia repairs

Inguinal hernia repair is one of the most common procedures in general surgery. All anesthetic methods can be used in inguinal hernia repairs. Local anesthesia for groin hernia repair had been introduced at the very beginning of the last century, and gained popularity following the success reports from the Shouldice Hospital, and the Lichtenstein Hernia Institute. Today, local anesthesia is routinely used in specialized hernia clinics, whereas its use is still not a common practice in general hospitals, in spite of its proven advantages and recommendations by current hernia repair guidelines. In this review, the technical options for local anaesthesia in groin hernia repairs, commonly used local anaesthetics and their doses, potential complications related to the technique are evaluated. A comparison of local, general and regional anesthesia methods is also presented. Local anaesthesia technique has a short learning curve requiring simple training. It is easy to learn and apply, and its use is in open anterior repairs a nice way for health care economics. Local anesthesia has been shown to have certain advantages over general and regional anesthesia in inguinal hernia repairs. It is more economic and requires a shorter time in the operating room and shorter stay in the institution. It causes less postoperative pain, requires less analgesic consumption; avoids nausea, vomiting, and urinary retention. Patients can mobilize and take oral liquids and solid foods much earlier. Most importantly, local anesthesia is the most suitable type of anesthesia in elder, fragile patients and patients with ASA II-IV scores.