Comparison of General, Epidural, and Spinal Anesthesia in Laparoscopic TEP (Total Extraperitoneal Repair) for Inguinal Hernia

Abstract

Purpose: Laparoscopic total extraperitoneal repair (TEP) is one of the most preferred minimally invasive methods for inguinal hernia repair. In our study, we aimed to compare the advantages and disadvantages of general anesthesia (GA), spinal anesthesia (SA), and epidural anesthesia (EA) for TEP operations.Materials and Methods: This is a retrospective study involving 221 patients who underwent TEP surgery for inguinal hernia between January 2018 and July 2020. Patients were divided into 3 groups as GA (n = 77), SA (n = 70), and EA (n = 74). Demographic data of the patients, duration of anesthesia and surgery, perioperative and postoperative complications, postoperative pain, anatomical delineation, hospital stay and quality of life were evaluated.Results: Anesthesia time was the longest in the EA group (23.1 ± 2.32 min) and significantly prolonged the operation time (P < 0.001). When the visual analog scale scores were compared, it was observed that the patients in the GA group felt significantly more pain (P < 0.001). While the rates of hypotension and headache were higher in regional anesthesia (P < 0.001 and P < 0.002), there was no significant difference in urinary retention, postoperative nausea/vomiting, and shoulder pain (P = 0.274, 0.262, and 0.314, respectively). SA and EA groups were found to be superior compared with the GA group in terms of patient satisfaction (P < 0.001). Conclusion: Regional anesthesia (SA and EA) can be safely performed in TEP surgeries, gives results similar to the anatomical delineation satisfactory and complication rates of GA, and results in less postoperative pain.

The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery

“…In studies in the literature, the incidence of urinary retention in TEP surgeries performed with RA has been reported as 7.3% to 19.4%. 3,7,[26][27][28] In our study, urinary retention was observed in 7.2% of the SA group and 12.5% of group 2, similar to the literature, and no significant difference was found between the 2 groups (P = 0.477).…”

“…In light of these factors, it has been reported in studies that patient satisfaction was found to be higher in the RA group. [3][4][5]24,26,27 In our study, although group 2 was higher than group 1 in terms of patient satisfaction, no significant difference was found between the 2 groups (P = 0.414).…”

“…4,5,24 In a TEP study comparing EA and GA, first-hour VAS scores were found to be significantly lower. 26 In a study by Ferahman et al, 27 in which SA, EA, and GA were compared, the VAS scores in the SA and EA groups were found to be significantly lower than in the GA group. In our study, VAS scores were found to be significantly lower in group 2 compared with group 1 at the 4th and 12th hours postoperatively (P < 0.001, P = 0.047, respectively).…”

“…In a retrospective clinical study by Ferahman et al, the operation time was found to be significantly higher for the EA group compared with the SA and GA (P < 0.001). 27 In one meta-analysis study comparing SA and GA, the total surgery time was found to be significantly lower in the GA group than in the SA group. 24 Similarly, in their meta-analysis study, Li et al 4 reported that the surgery time of the SA group was significantly longer than that of the GA group.…”

“…7 It has been reported that the incidence of headache varies between 7.3% and 11.1%. 3,7,[26][27][28] Conversely, meta-analyses have reported headaches to be more common with SA than GA. 4,5,24 In our study, though the numbers were slightly higher than in the literature-15% in group 2 and 12% in group 1-no significant difference was found between the 2 groups (P = 0.681).…”