Abstract ID: A25

Abstract Title: For Outpatient Inguinal Hernia Surgery Peripheral Nerve Block Offers Advantages Over General Anesthesia

Poster Type: Poster

ABSTRACT BODY

Introduction
Inguinal herniorrhaphy is now performed on an outpatient basis. The through-put of patients through an ambulatory surgery center may be enhanced by allowing patients who meet bypass criteria for Phase 1 PACU to be channeled directly to the Phase 2 area in order to be prepared for early discharge. The purpose of this study was to compare important perioperative time intervals and quality of recovery in patients having outpatient inguinal hernia surgery with paravertebral nerve block (PVBs) or general anesthesia (GA).

Methods
After IRB approval and informed consent, 50 patients (18-65 years old, ASA status = 1-3) were randomly assigned to receive either PVBs or a “fastrack” GA under standardized protocols (PVBs = 0.75% ropivacaine, followed by propofol sedation; GA = dolasetron 12.5 mg, propofol induction, rocuronium for muscle relaxation, followed by endotracheal intubation and desflurane in oxygen for maintenance; bupivacaine 0.25% for wound infiltration). Nurses blinded to the type of anesthesia and purpose of the study made decisions regarding eligibility for PACU bypass using Aldrete criteria. Additional data were collected regarding the time-to-postoperative pain, ambulation, home readiness, and incidence of adverse events.

Results
More patients in the PVB group (71%) met the criteria to bypass PACU as compared with patients in the GA group (8%; p < 0.001). Fewer patients in the PVB group had a pain (Visual Analogue Scale (VAS) score greater than 3) on arrival to the PACU as compared to the GA group (12 % vs 50 %; p = 0.005). Only 3 (13%) of patients in the PVB group requested treatment for pain while in the hospital compared with 12 (50%) patients in the GA group despite infiltration with local anesthetic (p = 0.005). Patients in the PVB group were able to ambulate earlier (102 ± 55 minutes) as compared with those in the GA group (213 ± 108 minutes; p < 0.001). Time-to-home readiness and discharge times were shorter for patients in the PVB group (156 ± 60 and 253 ± 37 minutes) compared with those in the GA group (203 ± 91 and 218 ± 93 minutes) (p < 0.001). Adverse events (e.g., nausea, vomiting, sore throat) and pain requiring treatment in the first 24 hours occurred less frequently in patients having PVB as compared to GA.

Discussion
Both PVBs and GA were associated with time efficient anesthesia. However, recovery in the PVBs group was faster and associated with fewer adverse events and better analgesia than GA even with wound infiltration with a local anesthetic.

ATTACHED FILES

Reg Anesth Pain Med 2004; 29(2):A25