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Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study

Authors Donmez T, Erdem VM, Sunamak O, Erdem DA, Avaroglu HI

Received 22 July 2016

Accepted for publication 10 September 2016

Published 27 October 2016 Volume 2016:12 Pages 1599—1608

DOI https://doi.org/10.2147/TCRM.S117891

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Professor Garry Walsh

Turgut Donmez,1 Vuslat Muslu Erdem,2 Oguzhan Sunamak,3 Duygu Ayfer Erdem,2 Huseyin Imam Avaroglu1

1Department of General Surgery, 2Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital, 3Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey

Background:
Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA). To date, no reports compare the efficacy of spinal anesthesia (SA) with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA.
Materials and methods: Between July 2015 and July 2016, 50 patients were prospectively randomized to either the GA TEP group (Group I) or the SA TEP group (Group II). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for GA. Hyperbaric bupivacaine (15 mg) and fentanyl (10 µg) were used for SA to achieve a sensorial level of T3. Intraoperative events related to SA, operative and anesthesia times, postoperative complications, and pain scores were recorded. Each patient was asked to evaluate the anesthetic technique by using a direct questionnaire filled in 3 months after the operation.
Results: All the procedures were completed by the allocated method of anesthesia as there were no conversions from SA to GA. Pain was significantly less for 1 h (P<0.0001) and 4 h (P=0.002) after the procedure for the SA and GA groups, respectively. There was no difference between the two groups regarding complications, hospital stay, recovery, or surgery time. Generally, patients were more satisfied with SA than GA (P<0.020).
Conclusion: TEP inguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better patient satisfaction than GA.

Keywords: spinal anesthesia, general anesthesia, TEP, inguinal hernia

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