Local Versus Spinal Anesthesia in Lichtenstein Mesh Technique for Inguinal Hernia Repair in Ambulatory Patients: A Randomized Controlled Trial

Abstract

Objective: This study aimed to determine whether Lichtenstein mesh Technique under local anesthesia results in better patient outcomes when compared with repair under spinal anesthesia. Methods: Patients > 18 years old, with primary, unilateral inguinal hernia handled between January 2008 to July 2010, and who fulfilled the specific inclusion criteria were enrolled. They were randomly assigned to either local anesthesia (LA), or, the spinal anesthesia (SA) groups. Outcome variables monitored included: total operative time, postoperative pain from days 1-7, complications, number of analgesic doses, and, time interval from surgery to resumption of routine occupational and sexual activities. Results: There were 101 patients (98 males and 3 female) LA group included 54 patients (52.5%) while the SA group, 48 patients (47.5%). Patients in LA group are younger in age but this is of no statistical significance (P=0.07). Significant differences between the two groups included: presence of urinary retention and more postoperative analgesia required within the first 24 hours among SA patients. Overall, LA group had less postoperative pain, fewer complications, and faster recovery with early resumption of occupational and sexual activities. Conclusion: This study offers significant evidence to prove that local anesthesia is a safe, cost-effective and practical alternative to spinal anesthesia for fast-track ambulatory inguinal hernia repair. Key words: inguinal hernia, lichtenstein mesh repair, local anesthesia, spinal anesthesia