Influence of anesthesia type on the wound healing after inguinal hernia surgeries

Abstract

Aim. To estimate the influence of anesthesia type on the inguinal hernia rate surgery complication rate, considering the hernia type. Methods. 276 patients aged 35-65 years treated for inguinal hernia (history of hernia from 3 months to 3 years) from 2007 to 2011 were analyzed. The surgery was performed using local anesthesia in 146 patients (first group) and using epidural anesthesia in 102 patients (second group); 28 patients underwent surgery using general anesthesia (third group). A combination of 4 mL 10% lidocaine, 20 mL of 7.5 mg/mL ropivacaine solution and 60 mL 0.9% saline were used for local anesthesia in patients of the first group. 2% solutions of lidocaine and ropivacaine were used for epidural or spinal anesthesia in patients of the second group. Results. Mean surgery duration was shortest at the first group - 50.5±1.2 min. Mean surgery duration at the second group was 73.2±2.2 min, 61.8±5.0 min - at the third group (р1,2 <0.001, р1,3=0.003, р2,3=0.017). Mean activation terms were 4.2±0,1 hours for the patients of the first group (local anesthesia), 20.3±0.2 hours - for the patients of the second group (epidural anesthesia), 10.5±0.2 hours - for the patients of the second group (general anesthesia). Postoperative pain measured by visual analogue scale occurred at significantly shorter terms after the surgery and was more intense for the first 3 days in patients of the first group. The pain intensity elevated gradually in patients of the first group starting from the second day after the surgery, pain lasted significantly in the second and third group patients compared to the first group. Complications were registered in 15 (10.3%) of the first group patients, in 12 (11.8%) of the second group patients and in 5 (17.9%) of the third group patients (р1,2=0.836; р1,3=0.237; р2,3=0.525). Conclusion. A combination of analgesics solutions based on their pharmacologic features and two-phase vasoactivity ability has shown good analgesic effect at local anesthesia. The type of anesthesia determines the duration of surgery and the rate of post-surgical complications as a consequence.

Keywords

analgesia / anesthesia / hernia surgery / complication / ultrasound duplex angiography

References

[1] Адамян А.А., Фёдоров А.В., Гогия Б.Ж. К вопросу о классификации паховых грыж // Хирургия (Ж. им. Н.И. Пирогова). - 2007. - №11. - С. 44-45.

[2] Власов В.В., Суходоля А.В., Грешило О.О., Микитюк С.Р. Оценка качества жизни у пациентов после хирургического лечения паховой грыжи // Вестн. герниол. - 2008. - №3. - С. 42-47.

[3] Горчакова Н.А., Гудивок Я.С., Гунина Л.М. и др. Фармакология спорта. - Казань: Олимпийская литература, 2010. - 640 с.

[4] Егиев В.Н., Лядов К.В., Рутенбург Г.М., Фёдоров А.В. Ненатяжная герниопластика - М.: Медпрактика, 2002. - С. 136-141.

[5] Кунцевич Г.И., Адамян А.А., Гогия Б.Ш. Применение комплексного ультразвукового исследования в диагностике паховых грыж на этапах хирургического лечения // Ультразвук. и функционал. диагност. - 2004. - №3. - С. 31.

[6] Лелюк В.Г., Лелюк С.Э. Ультразвуковая ангиология. - М.: Реальное время, 2003. - С. 86-88, 115-124.

[7] Малрой М. Местная анестезия. - М.: Бином, 2005. - С. 21, 32-35.

[8] Новиков К.В., Раев В.К., Бутузов В.Г. и др. Болевой синдром после пахового грыжесечения, выполненного в условиях дневного хирургического стационара // Хирургия. - 2002. - №12. - С. 34-37.

[9] Овечкин А.М., Гнездилов А.М. Наропин (ропивакаин) в лечении боли: идеальный выбор? // Вестн. интенсив. терап. - 2000. - №3. - С. 54-59.

[10] Овечкин А.М., Карпов И.А., Люосев С.В. Послеоперационное обезболивание в абдоминальной хирургии: новый взгляд на старую проблему // Анестезиол. и реаниматол. - 2003. - №5. - С. 47-48.

[11] Славин Л.Е., Фёдоров И.В., Сигал Е.И. Осложнения хирургии грыж живота. - М.: Профиль, 2005. - 147 с.

[12] Milgalter E., Pearl J.M., Laks H. et al. The inferior epigastric anteries as coronary bypass conduits. Size, preoperative duplex scan assessment of suitability, and early clinical experience // J. Thorac. Cardiovasc. Surg. - 1992. - Vol. 103, N 3. - P. 463-465.

[13] Carpenter R. Local anesthetic toxicity: the case for ropivacaine // Anesth. Analg. - 1997. - Vol. 24. - Р. 4-7.

[14] McClure J. Ropivacaine // Br. J. Anaesth. - 1996. - Vol. 76. - P. 300-307.

[15] Rosenberg P. Maximum recommended doses of local anaesthetics - need for new recommendations? Highlights in regional anaesthesia and pain therapy XI. Special edition world congress on regional anaesthesia and pain therapy. - Barselona: Spain, 2002. - P. 30-34.

RIGHTS & PERMISSIONS

Slavin L.E., Aliullova R.R., Borisova I.U., Chugunov A.N.