• analgesia
• anesthesia
• ropivacaine
• surgery
• thyroid
• thyroidectomy

• Acute Pain
• Analgesics, Opioid
• Anesthesia, Spinal
• Injections, Spinal
• Meta-Analysis

• inguinal hernia repair
• meta-analysis
• regional block anesthesia
• systematic review

• Adult
• Analgesics/therapeutic use
• Anesthesia, Conduction
• Hernia, Inguinal/surgery
• Humans
• Nausea/chemically induced
• Pain, Postoperative/chemically induced
• Pain, Postoperative/etiology
• Randomized Controlled Trials as Topic
• Vomiting/chemically induced

Background

Associated advantages of ilioinguinal/iliohypogastric block and sedation versus general anesthesia (GA) for inguinal hernia repair have not been reported. The use of regional anesthesia (RA) is advantageous during the COVID-19 pandemic as it eliminates the need for airway manipulation.This study aimed to determine the association between postoperative recovery time when ilioinguinal/iliohypogastric block and sedation were utilized for inguinal hernia versus GA.

Method

This single-center retrospective study used multivariable logistic regression to model the anesthetic modality as a function of age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, major comorbidities to generate a propensity score for each patient for matching.

Results

After screening 295 patients, 80 patients each in the general and regional anesthesia groups were matched.RA was associated with a 35.6 minutes (95% CI: -46.6 to -25.0) shorter total postoperative recovery time when compared to GA without the increased preoperative time and adverse outcomes.

Conclusions

Inguinal hernia repair, when performed under ilioinguinal/iliohypogastric block and sedation, was associated with reduced postoperative recovery time. This can be advantageous during the time of the COVID-19 pandemic to reduce the risk of aerosol generation and shorten hospital stay. Future research can focus on establishing a causal relationship.

• Bilateral inguinal herniorrhaphy
• Dexmedetomidine
• Magnesium sulphate
• Spinal anesthesia

• Adjuvants
• clonidine
• dexmedetomidine
• postoperative analgesia
• rescue analgesia
• ropivacaine
• spinal anesthesia

• Geriatric anesthesia
• Nerve block
• Postoperative pain

Inguinal hernia repair (IHR) is a common surgical procedure which can be performed under general, regional, or peripheral nerve block anesthesia.

The aim of our study was to compare the efficacy of paravertebral block (PVB) with spinal anesthesia (SA) for IHR with respect to postoperative analgesia, ambulation, and adverse effects.

This was a prospective, single-blind randomized controlled trial.

Sixty American Society of Anesthesiologists Class I–II patients of 20–60 years scheduled for IHR were randomized by a computer-generated list into two groups of thirty each, to receive either PVB (Group PVB: at T12–L2 levels, 10 ml of 0.5% levobupivacaine at each level) or SA (Group SA: at L3–L4/L2–L3 level, 2.5 ml of 0.5% levobupivacaine). Primary outcome was duration of postoperative analgesia and time to reach discharge criteria. Secondary outcome was time to ambulation, time to perform the block, time to surgical anesthesia, total rescue analgesic consumption, adverse effects, hemodynamic changes, patient, and surgeon satisfaction.

Student's t-test, Chi-square test as applicable, and Statistical Package for Social Sciences (version 14.0, SPSS Inc., Chicago, IL, USA) were used.

Time to the first analgesic requirement was 15.17 ± 3.35 h in Group PVB and 4.67 ± 1.03 h in Group SA (P < 0.001). Time to reach the discharge criteria was significantly shorter in Group PVB than Group SA (P < 0.001).

PVB is advantageous in terms of prolonged postoperative analgesia and encourages early ambulation compared to SA.

• Inguinal hernia
• paravertebral block
• spinal anesthesia

Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action. A large array of opioids ranging from morphine, fentanyl and sufentanyl to hydromorphone, buprenorphine and tramadol has been used with varying success. However, their use has been limited by their adverse effect like respiratory depression, nausea, vomiting and pruritus, especially with its neuraxial use. Epinephrine potentiates the local anesthetics by its antinociceptive properties mediated by alpha-2 adrenoreceptor activation along with its vasoconstrictive properties limiting the systemic absorption of local anesthetics. Alpha 2 adrenoreceptor antagonists like clonidine and dexmedetomidine are one of the most widely used class of local anesthetic adjuvants. Other drugs like steroids (dexamethasone), anti-inflammatory agents (parecoxib and lornoxicam), midazolam, ketamine, magnesium sulfate and neostigmine have also been used with mixed success. The concern regarding the safety profile of these adjuvants is due to its potential neurotoxicity and neurological complications which necessitate further research in this direction. Current research is directed towards a search for agents and techniques which would prolong local anaesthetic action without its deleterious effects. This includes novel approaches like use of charged molecules to produce local anaesthetic action (tonicaine and n butyl tetracaine), new age delivery mechanisms for prolonged bioavailability (liposomal, microspheres and cyclodextrin systems) and further studies with other drugs (adenosine, neuromuscular blockers, dextrans).

• Local anesthetics
• Adjuvants
• Neurotoxicity
• Opioids
• Ketamine
• Midazolam
• Alpha-2 adrenoreceptor antagonists

Ambulatory anesthesia allows quick recovery from anesthesia, leading to an early discharge and rapid resumption of daily activities, which can be of great benefit to patients, healthcare providers, third-party payers, and hospitals. Recently, with the development of minimally invasive surgical techniques and short-acting anesthetics, the use of ambulatory surgery has grown rapidly. Additionally, as the indications for ambulatory surgery have widened, the surgical methods have become more complex and the number of comorbidities has increased. For successful and safe ambulatory anesthesia, the anesthesiologist must consider various factors relating to the patient. Among them, appropriate selection of patients and surgical and anesthetic methods, as well as postoperative management, should be considered simultaneously. Patient selection is a particularly important factor. Appropriate surgical and anesthetic techniques should be used to minimize postoperative complications, especially postoperative pain, nausea, and vomiting. Patients and their caregivers should be fully informed of specific care guidelines and appropriate responses to emergency situations on discharge from the hospital. During this process, close communication between patients and medical staff, as well as postoperative follow-up appointments, should be ensured. In summary, safe and convenient methods to ensure the patient's return to function and recovery are necessary.

• Ambulatory surgical procedures
• Anesthesia
• Patient safety
• Patient selection

Chronic inguinodynia (groin pain) is a common complication following open inguinal hernia repair or a Pfannenstiel incision but may also be experienced after other types of (groin) surgery. If conservative treatments are to no avail, tailored remedial surgery, including a neurectomy and/or a (partial) meshectomy, may be considered. Retrospective studies in patients with chronic inguinodynia suggested that spinal anaesthesia is superior compared to general anaesthesia in terms of pain relief following remedial operations. This randomised controlled trial is designed to study the effect of type of anaesthesia (spinal or general) on pain relief following remedial surgery for inguinodynia.

A total of 190 adult patients who suffer from unacceptable chronic (more than 3 months) inguinodynia, as subjectively judged by the patients themselves, are included. Only patients scheduled to undergo a neurectomy and/or a meshectomy by an open approach are considered for inclusion and randomised to spinal or general anaesthesia. Patients are excluded if pain is attributable to abdominal causes or if any contraindications for either type of anaesthesia are present. Primary outcome is effect of type of anaesthesia on pain relief. Secondary outcomes include patient satisfaction, quality of life, use of analgesics and (in)direct medical costs. Patient follow-up period is one year.

The first patient was included in January 2016. The expected trial deadline is December 2019. Potential effects are deemed related to the entire setting of type of anaesthesia. Since any setting is multifactorial, all of these factors may influence the outcome measures.

This is the first large randomised controlled trial comparing the two most frequently used anaesthetic techniques in remedial surgery for groin pain. There is a definite need for evidence-based strategies to optimise results of these types of surgery. Besides pain relief, other important patient-related outcome measures are assessed to include patient’s perspectives on outcome.

The protocol (protocol number NL54115.015.15) is approved by the Medical Ethics Committee of Máxima Medical Centre, Veldhoven, The Netherlands. The study protocol was registered at www.trialregister.nl (NTR registration number: 5586) on 15 January 2016.

The online version of this article (doi:10.1186/s13063-016-1746-x) contains supplementary material, which is available to authorized users.

• Anesthesia
• Chronic pain
• Operative
• Pain
• Pain management
• Postoperative
• Randomised controlled trail [publication type]
• Surgical procedures

• Anaesthetic technique
• early ambulation
• inguinal hernia repair
• paravertebral block
• spinal

• ilioinguinal nerve block
• inguinal hernia repair
• monitored anesthesia care
• outpatient surgery
• point-of-care ultrasound
• transversus abdominis plane block
• ultrasound-guided regional anesthesia

• Aged
• Anesthesia, Conduction/methods
• Anesthetics, Local/administration & dosage
• Female
• Hernia/diagnostic imaging
• Herniorrhaphy/methods
• Humans
• Male
• Middle Aged
• Nerve Block/methods
• Retrospective Studies
• Treatment Outcome
• Ultrasonography, Interventional/methods

The Ilioinguinal/iliohypogastric nerve block has been shown to significantly decrease opioid analgesic requirements and side effects after inguinal herniotomy. We compared the effect of pre-incisional field block with 0.25% bupivacaine and post-incisional wound infiltration with 0.25% bupivacaine for postoperative pain control after inguinal herniotomy.

This was a randomized controlled double blind study in 62 ASA I and II children aged 1-7 years scheduled for inguinal herniotomy. They were assigned to receive either pre-incision field block (group I) or post-incision wound infiltration at the time of wound closure (group II). The pain score was assessed in the recovery room using mCHEOPS score and VAS or FLACC score at home by the parents for 24 hours.

The mean pain scores during the 2 hour stay in the recovery room, at 12 and 18 hours at home were similar in both groups, p > 0.05. However, the mean pain scores were significantly lower at 6 hours at home in group I (1.22 ± 0.57) than in group II (1.58 ±0.90), p <0.001, but significantly higher at 24 hours at home in group I (3.29 ± 0.46) than in group II (2.32 ± 0.24), p = 0.040. There was no difference in mean paracetamol requirement, and in the number of patients who required paracetamol for pain relief at home in both groups, p > 0.05.

We have demonstrated that both pre-incisional ilioinguinal/iliohypogastric field block and post incisional wound infiltration provided adequate postoperative analgesia for 24 hours after inguinal herniotomy.

• Herniotomy
• Preincisional ilioinguinal/iliohypogastric nerve block
• pain score
• postincisional wound infiltration

Patient's awareness can be reduced during ultrasound guided nerve block for inguinal herniorraphy with propofol sedation. The study was aimed to evaluate the clinical efficacy of direct visualization of anatomy of inguinal region by ultrasound and benefits of bispectral index (BIS) monitoring.

After approval, 40 adult male consented patients of ASA grade I-III of 18-58 years with body mass index <25 were randomized into two groups of 20 patients each. A high frequency (8-13 MHz) linear transducer was used to perform the ilioinguinal and iliohypogastric nerves (ILHN and ILIN) block between the internal oblique and transversus abdominis muscles with 20 mL of 0.75% ropivacaine. The propofol infusion rate for sedation in patients of group I (non-BIS) was managed clinically and in patients of group II (BIS) was managed with BIS index of 65-75. Any surgical or anesthetic complications were recorded. The two groups were compared by evaluating the propofol consumption during surgery.

Ultrasonographic visualization of the ILHN and ILIN was possible in all patients and inguinal herniorraphy was performed uneventfully. The mean dose of propofol required for sedation was 5.45 mg/kg/h in patients of group I (non-BIS) while 4.92 mg/kg/h in patients of group II (BIS). The mean propofol consumption was not statistically significant (P = 0.12). All patients were hemodynamically stable and there was no respiratory depression during propofol sedation.

Ultrasonography has facilitated the clinically effective nerve block for inguinal herniorraphy and BIS monitoring has ensured amnesia and faster emergence.

• Bispectral index
• iliohypogastric nerve
• ilioinguinal nerve
• propofol
• ultrasound guidance

The aim was to evaluate general anesthesia (GA) plus ilioinguinal nerve block (IIB) versus spinal anesthesia (SA) in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications.

A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, maintenance with sevoflurane, airway management with laryngeal mask allowing spontaneous ventilation and ultrasound-guided IIB; SA group, patients who underwent spinal block with 2% mepivacaine. The study variables were pain intensity, assessed by visual analog scale, analgesic requirements until hospital discharge, time to ambulation and discharge, postoperative complications-related to both techniques and satisfaction experienced.

Thirty-two patients were enrolled; 16 patients in each group. The differences regarding pain were statistically significant at 2 h of admission (P < 0.001) and at discharge (P < 0.001) in favor of the GA plus ilioinguinal block group. In addition in this group, analgesic requirements were lower than SA group (P < 0.001), with times of ambulation and discharge significantly shorter. The SA group had a higher tendency to develop complications and less satisfaction.

General anesthesia plus IIB is better than SA regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients.

• Ambulatory surgical procedures
• analgesia
• general anesthesia
• inguinal hernia
• nerve block
• pain management
• spinal anesthesia

Inguinal hernia is one of the most common diseases in the elderly. Treatment of this pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia.

The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine to the same obtained by bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from March 2011 to March 2013. We collected data of eighty patients, male and female, aged between 65 and 86 years, who underwent inguinal hernioplasty with local anesthesia.

Evaluation of intra-operatively pain shows that minimal pain is the same in both groups. Mild pain was more frequent in the group who used levobupivacaine. Moderate pain was slightly more frequent in the group who used bupivacaine. Only one reported intense pain. Two drugs seem to have the same effect at a distance of six, twelve, eighteen and twentyfour hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. Degree of satisfaction expressed by patients has been the same in the two groups. Levobupivacaine group has shown a greater request for paracetamol while patients who experienced bupivacaine have showed a higher request of other analgesics.

Clinical efficacy of levobupivacaine and racemic bupivacaine are actually similar, when used under local intervention of inguinal hernioplasty. In the field of ambulatorial surgery our working group prefers levobupivacaine for its fewer side effects and for its easy handling.

The inguinal hernia is one of the most common diseases in the elderly. Treatment of this type of pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia.

The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine compared with that of bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from April 2010 to May 2012. We collected data of forty male patients, aged between 73 and 85 years, who underwent inguinal hernioplasty with local anesthesia for the first time.

Minimal pain is the same in both groups. Mild pain was more frequent in the group who used bupivacaine, moderate pain was slightly more frequent in the group who used levobupivacaine, and the same for intense pain. It is therefore evident how Bupivacaine is slightly less preferred after four and twenty four hours, while the two drugs seem to have the same effect at a distance of twelve and forty-eight hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. The request for an analgesic was slightly higher in patients receiving levobupivacaine.

After considering all these elements, we can conclude that the clinical efficacy of levobupivacaine and racemic bupivacaine are essentially similar, when used under local intervention of inguinal hernioplasty.

• Anesthesia/methods
• Cross-Sectional Studies
• Female
• Hernia, Inguinal/surgery
• Herniorrhaphy
• Humans
• Male
• Middle Aged
• Spain

• Adolescent
• Adult
• Aged
• Analgesics/therapeutic use
• Anesthesia Recovery Period
• Anesthesia, Spinal/adverse effects
• Anesthesia, Spinal/methods
• Anesthetics, Intravenous/administration & dosage
• Anesthetics, Local/administration & dosage
• Blood Pressure/drug effects
• Bupivacaine/administration & dosage
• Hernia, Inguinal/surgery
• Humans
• Lidocaine/administration & dosage
• Male
• Middle Aged
• Nerve Block/adverse effects
• Nerve Block/methods
• Pain Measurement
• Pain, Postoperative/prevention & control
• Postoperative Nausea and Vomiting/etiology
• Propofol/administration & dosage
• Spinal Nerve Roots/drug effects
• Time Factors
• Urinary Retention/etiology
• Walking/physiology
• Young Adult

• Analgesia/methods
• Analgesia/trends
• Anesthesia Recovery Period
• Anesthesiology/methods
• Anesthesiology/trends
• Elective Surgical Procedures/methods
• Humans
• Perioperative Care/methods
• Perioperative Care/trends
• Physician's Role

• Ambulatory Surgical Procedures
• Anesthesia, Conduction/adverse effects
• Anesthesia, General/adverse effects
• Benzylisoquinolines
• Cholinesterase Inhibitors/adverse effects
• Humans
• Intubation, Intratracheal
• Isoquinolines
• Mivacurium
• Muscle Relaxants, Central
• Neuromuscular Depolarizing Agents/adverse effects
• Neuromuscular Nondepolarizing Agents/adverse effects
• Pain, Postoperative/chemically induced
• Paralysis/chemically induced
• Paralysis/drug therapy
• Postoperative Nausea and Vomiting/chemically induced
• Practice Guidelines as Topic
• Risk Assessment
• Steroids
• Succinylcholine
• Sugammadex
• gamma-Cyclodextrins/therapeutic use

• Adolescent
• Adult
• Black or African American/statistics & numerical data
• Aged
• Anesthesia/economics
• Anesthesia/methods
• Anesthesia/statistics & numerical data
• Anesthesia, Epidural/statistics & numerical data
• Anesthesia, General/statistics & numerical data
• Cohort Studies
• Female
• Hernia, Inguinal/surgery
• Humans
• Insurance, Health/statistics & numerical data
• Male
• Middle Aged
• Minority Groups/statistics & numerical data
• Multivariate Analysis
• Odds Ratio
• Prejudice
• Regression Analysis
• Retrospective Studies
• Sex Factors
• Surgicenters/economics
• Surgicenters/statistics & numerical data
• United States
• White People/statistics & numerical data

• Autonomic Nerve Block/methods
• Choice Behavior
• Hernia, Inguinal/surgery
• Humans
• Peripheral Nerves/physiology

• Adult
• Aged
• Amides/therapeutic use
• Anesthesia Recovery Period
• Anesthesia, General/methods
• Autonomic Nerve Block/methods
• Chi-Square Distribution
• Confidence Intervals
• Female
• Follow-Up Studies
• Hernia, Inguinal/drug therapy
• Hernia, Inguinal/surgery
• Humans
• Male
• Middle Aged
• Pain, Postoperative/drug therapy
• Pain, Postoperative/prevention & control
• Ropivacaine
• Single-Blind Method

• Anesthetics, Local
• Contraindications
• Humans
• Hypogastric Plexus
• Inguinal Canal
• Nerve Block/adverse effects

• Acute Disease
• Airway Obstruction/etiology
• Airway Obstruction/therapy
• Catheterization, Peripheral/methods
• Endarterectomy, Carotid/adverse effects
• Fiber Optic Technology
• Humans
• Intubation, Intratracheal/methods
• Laryngeal Masks
• Male
• Middle Aged
• Postoperative Hemorrhage/complications

• Equipment Design
• Esophagus
• Humans
• Intubation/instrumentation
• Intubation, Intratracheal/instrumentation
• Laryngeal Masks
• Randomized Controlled Trials as Topic

• Adolescent
• Adult
• Aged
• Ambulatory Surgical Procedures
• Analgesics, Opioid/administration & dosage
• Analgesics, Opioid/therapeutic use
• Anesthesia Recovery Period
• Anesthetics, Local
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Cyclooxygenase 2
• Cyclooxygenase 2 Inhibitors
• Cyclooxygenase Inhibitors/therapeutic use
• Female
• Hernia, Inguinal/surgery
• Humans
• Lactones/therapeutic use
• Length of Stay
• Male
• Membrane Proteins
• Middle Aged
• Motor Activity
• Nerve Block
• Pain Measurement/drug effects
• Pain, Postoperative/prevention & control
• Patient Satisfaction
• Postoperative Complications/epidemiology
• Prostaglandin-Endoperoxide Synthases/metabolism
• Sulfones/therapeutic use
• Treatment Outcome

• Anesthesia
• Anesthesia, Conduction
• Anesthesia, General
• Anesthesia, Local
• Hernia, Inguinal/surgery
• Humans
• Surgical Procedures, Operative

• Adult
• Aged
• Aged, 80 and over
• Anesthesia, Local/methods
• Anesthetics, Local
• Bupivacaine
• Double-Blind Method
• Hernia, Inguinal/surgery
• Humans
• Intraoperative Complications/prevention & control
• Male
• Middle Aged
• Nerve Block/methods
• Pain/prevention & control
• Pain Measurement/methods

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Ambulatory Surgical Procedures/statistics & numerical data
• Anesthesia, Conduction/statistics & numerical data
• Anesthesia, General/statistics & numerical data
• Anesthesia, Local/statistics & numerical data
• Denmark
• Health Care Surveys/statistics & numerical data
• Hernia, Inguinal/surgery
• Humans
• Middle Aged
• Pain/prevention & control

• Anesthesia, General/adverse effects
• Anesthesia, General/methods
• Anesthetics, Local/adverse effects
• Anesthetics, Local/therapeutic use
• Hernia, Inguinal/surgery
• Humans
• Pain/prevention & control
• Patient Satisfaction