Local or general anesthesia for open hernia repair: a randomized trial

<b>Objective</b>: To compare patient outcome following repair of a primary groin hernia under local (LA) or general anesthesia (GA) in a randomized clinical trial. <b>Summary Background Data</b>: LA hernia repair is thought to be safer for patients, causes less postoperative pain, cost less, and is associated with a more rapid recovery when compared with the same operation performed under GA. <b>Methods</b>: All patients presenting to three surgeons during the study period with a primary groin hernia were considered eligible. Outcome parameters measured including tests of vigilance, divided attention, sustained attention, memory, cognitive function, pain, return to normal activity, and costs. <b>Results</b>: Two hundred seventy-nine patients were randomized to LA or GA hernia repair; 276 of these had an operation, with 138 participants in each group. At 6, 24, and 72 hours postoperatively there were no differences in vigilance or divided attention between the groups. Similarly, memory, sustained attention, and cognitive function were not impaired in either group. Although physical activity was significantly impaired at 24 hours, this and return to usual social activities were similar in both groups. While patients in the LA group had significantly less pain on moving, at 6 hours they were less likely to recommend the same operation to someone else. GA hernia repair cost 4% more than the same operation under LA. <b>Conclusions</b>: There are no major differences in patient recovery after LA or GA hernia repair. Patients should be offered a choice of anesthesia, LA or GA, for repair of their groin hernia. There has been a renewed interest in the use of local anesthesia (LA) for inguinal hernia repair. This has been brought about by the rapid introduction of tension-free hernioplasty, which is thought to be easier to perform than conventional methods of hernia repair. 1 The advantages claimed for the use of LA include increased safety for patients, better postoperative pain control, shorter recovery period, and reduced cost when compared with hernia repair performed under general anesthesia (GA). It is not possible to assess differences in safety between LA and GA hernia repair as mortality and serious cardiovascular events are so low following this procedure. 2 GA, however, has been thought to have a significant effect on psychomotor skills, attention, and memory in the postanesthesia period. Some authors have suggested this effect may be long term and related to cerebral ischemia. 3 This is thought to be particularly the case in elderly patients with significant comorbid disease. Given that local anesthetics have little or no serious CNS effects, one might anticipate that their use would be associated with better outcomes in terms of cognitive function. We report a randomized clinical trial comparing LA and GA open hernia repair