Psychomotor recovery was assessed using tasks with known sensitivity to the effects of anesthetic and other sedative drugs. A record of analgesia use in the postoperative period was maintained for both groups of patients all completed visual analog pain scores at rest and on moving preoperatively and 6, 24, and 72 hours postoperatively. Patients who experienced pain in the recovery room were allowed intravenous increments of morphine 1 to 2 mg as required every 5 minutes until comfortable. They were also prescribed diclofenac sodium twice daily (Voltarol SR 75 mg) unless contraindicated and Coproxamol two tablets every 4 hours as required (maximum 8 tablets per 24 hours) for the duration of their hospital stay. All groups received infiltration of bupivacaine 0.25% into the surgical wounds for postoperative analgesia. They were then allowed to breathe spontaneously a mixture of 60% nitrous oxide in oxygen with isoflurane 1% to 1.5% through a laryngeal mask. Patients randomized into the GA group were induced with propofol 2 mg/kg and fentanyl 1 mcg/kg. Patients who required sedation or analgesia during surgery were given 1-mL intravenous increments of a mixture containing midazolam (1 mg/mL) and fentanyl (10 mcg/mL) intravenously. Patients randomized to the LA group received their anesthesia similar to that described by Amid et al., 1 except that 1% lidocaine with adrenaline (1:200,000) was used instead of a mixture of lidocaine and bupivacaine.
#HERNIA FREE CLINICAL TRIALS TRIAL#
We report a randomized clinical trial comparing LA and GA open hernia repair.Īll patients received premedication 1 to 2 hours before surgery (temazepam 30 mg, metoclopramide 10 mg, diclofenac sodium 75 mg) unless contraindicated. 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. 3 This is thought to be particularly the case in elderly patients with significant comorbid disease.
Some authors have suggested this effect may be long term and related to cerebral ischemia.
2 GA, however, has been thought to have a significant effect on psychomotor skills, attention, and memory in the postanesthesia period. 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. 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). 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. There has been a renewed interest in the use of local anesthesia (LA) for inguinal hernia repair.