Comparative study of lichtenstein’s hernia repair under local anaesthesia and spinal anaesthesia

Inguinal hernia is one of the most common disease in male population. Treatment is surgical. While in the past, hernia surgery was done under general and spinal anaesthesia, in recent years the role of local anaesthesia plays a major role in terms of cost effectiveness, patients cooperation on table and time saved during surgery. AIM OF THE STUDY: To compare safety and effectiveness of lichtenstein repair under local anaesthesia versus spinal anaesthesia in relation with post operative pain, complications and hospital stay. MATERIALS AND METHODS: This prospective study of 50 cases of unilateral inguinal hernia admitted in Government Mohan Kumaramangalam Medical College Hospital, Salem was done in the period from DECEMBER 2015 to SEPTEMBER 2017. The cases were evaluated through proper history taking, clinical examination, operative procedure and post operative follow ups. OBSERVATION: In our study the mean age in Group A was 44.36+/-11.69 and in group B was 40.44+/-10.18. Incidence of indirect inguinal hernia was common in age group of 21 to 45 years in group A and 22 to 47 years in Group B. Direct hernia incidence was common in age group 47 to 71 years. The time taken for hernioplasty under local anaesthesia was from 40 mins to 70 mins but to finish under spinal anaesthesia was prolonged from 40 mins to 100 mins. Hence local anaesthesia was a better choice. The pain felt during surgery was significantly less in group A when compared to group B.Postop pain was measured using the visual analogue scale at 12 hrs , 24 hrs and 48 hrs.Mean pain was significantly less in group A as compared to Group B. Post operative complication were high in Group B when compared to Group A. Patients had complications like urinary retention, headache. Spinal anesthesia related complications were high. The number of analgesic doses received postoperatively was more in group A was very less compared to Group B. around 8 patients in group B received 5 to 6 analgesic doses postoperatively. Mean analgesic dose received in Group A patients (2.12+/-1.23) as compared to Group B patients ((3.44+/-1.58) Number of days of hospital stay was significantly less in Group A when compared to Group B. 19 patients in group B had to stay 3 to 5 days in the hospital whereas in group A most of the patients were discharged on day 1 or 2. Group A patients were cost effective than Group B when the drugs used, number of analgesic doses used and number of days of hospital stay are considered. CONCLUSION: Lichtenstein tension free hernioplasty under local anaesthesia is an extremely safe day care operation. It is inexpensive and effective procedure and the benefits are low morbidity and early return to normal activities.It results in faster recovery speedy discharge and less anaesthesia related complications