The Efficacy of Epidural Anesthesia for Endoscopic Preperitoneal Herniorrhaphy: A Prospective Study

Abstract

Laparoscopic herniorrhaphy has been criticized because of the need for general anesthesia. The endoscopic preperitoneal approach allows the use of epidural anesthesia, obviating the potential complications and side effects seen with general anesthesia. The purpose of this study was to determine the efficacy of epidural anesthesia for preperitoneal herniorrhaphy. Fifty-two patients underwent repair of a total of 80 hernias over a 6-month period. Thirty-six patients underwent their repairs with the use of epidural anesthesia with the goal of a T-4 sensory level. A tension-free prosthetic repair was performed in all patients. Seventeen patients had unilateral repairs and nineteen had bilateral repairs under epidural, while seven patients had unilateral repairs and nine patients had bilateral repairs under general anesthesia. There were no significant differences in patient demographics. All herniorrhaphies were electively performed on an outpatient basis by a single surgeon (A.L.S.) in a teaching setting. There were no significant differences for unilateral and bilateral repairs when type of anesthesia was compared. There was only one conversion from epidural to general anesthesia, secondary to poor sensory blockade first noticed during creation of the preperitoneal space (97% success rate). Seven patients receiving epidural anesthesia experienced pneumoperitoneum during the procedure. This did not effect the ability to perform the hernia repair successfully. There were no complications related to the epidural anesthetic. Endoscopic preperitoneal herniorrhaphy can be performed effectively under epidural anesthesia, obviating the need for general anesthesia.

Clinical effects of intrathecal fentanyl on shoulder tip pain in laparoscopic total extraperitoneal inguinal hernia repair under spinal anaesthesia: A double-blind, prospective, randomized controlled trial

“…Ismail and Garg 6 used 4 ml of 0.5% hyperbaric bupivacaine for TEP under spinal anaesthesia, but did not mention an adequate anaesthetic level. Lal et al 7 and Azurin et al 24 recommended that a sensory level of above T6 7 and above T4, 24 was adequate for the success of TEP under epidural anaesthesia. On the basis of other reports, 5,7,24 the block level was regarded as T6 in the present study.…”

“…Lal et al 7 and Azurin et al 24 recommended that a sensory level of above T6 7 and above T4, 24 was adequate for the success of TEP under epidural anaesthesia. On the basis of other reports, 5,7,24 the block level was regarded as T6 in the present study. However, we used 2.8 ml of bupivacaine in the control group and 2.6 ml in the experimental group because the patients enrolled in the present study were smaller and older than those enrolled in previous studies.…”

Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease

“…In the past decade, many surgeons published case reports of laparoscopic cholecystectomy that was performed on pregnant and nonpregnant patients while they were under epidural anesthesia [7,9,19,21]. Azurin et al [2] obtained excellent results when they used this type of anesthesia during laparoscopic preperitoneal treatment of inguinal hernias.…”

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

“…However, the anesthetic technique should be tailored to the type of surgery. General anesthesia (balanced anesthesia technique with several intravenous and inhalational agents and the use of muscle relaxants), peripheral nerve blocks, and neuraxial anesthesia as an alternative to general anesthesia for outpatient pelvic laparoscopy, local anesthesia infiltration in microlaparoscopy for limited and precise gynecological procedures, and intravenous sedation can be used with a safe profile for patients and have been described in the literature (LE 5) [364], (LE 4) [365], (LE 2b) [366,367], (LE 1b) [368], (LE 1a) [369], (LE 4) [370], (LE 1b) [371,372], (LE 2b) [373,374], (LE 1b) [375]. Laparoscopy is most commonly performed with the patient under general anesthesia, especially for prolonged and upper abdominal procedures.…”