Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair

Study objective: Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TWA patients. Design: Randomized, prospective trial. Setting: University hospital day-surgery center. Patients: 156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy. Interventions: Patients were randomized to either LAI (lidocaine + ropivacaine), SPIN (bupivacaine + fentanyl) or TWA (propofol + remifentanil). Perioperative Ringer infusion was 1.5 mL/h. Urinary bladder was scanned before and after surgery. Interviews were performed on postoperative days 1, 7 and 90. Measurements: Duration of surgery, duration of the patients' stay in the operating room and time until their readiness for discharge home. Patient satisfaction and adverse effects were registered. Main results: Surgery lasted longer in LAI group (median 40 min) than in SPIN group (35 min) (P = .003) and TWA group (33 min) (P