E Bojaxhi1, J Lee2,3, S Bowers4, R D Frank5, S H Pak2,6, A Rosales4,7, S Padron2,8, R A Greengrass2. 1. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA. bojaxhi.elird@mayo.edu. 2. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA. 3. Department of Anesthesiology, Good Samaritan Hospital, Mount Vernon, IL, USA. 4. Department of Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA. 5. Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. 6. Department of Anesthesiology, St. Vincent's Hospital, Jacksonville, FL, USA. 7. Department of Surgery, Cleveland Clinic Florida, Weston, FL, USA. 8. Nova Southeastern University School of Medicine, Fort Lauderdale, FL, USA.
Abstract
PURPOSE: Inguinal hernia repair and general anesthesia (GA) are known risk factors for urinary retention. Paravertebral blocks (PVBs) have been utilized to facilitate enhanced recovery after surgery. We evaluate the benefit of incorporating PVBs into our anesthetic technique in a large cohort of ambulatory patients undergoing inguinal hernia repair. METHODS: Records of 619 adults scheduled for ambulatory inguinal hernia repair between 2010 and 2015 were reviewed and categorized based on anesthetic and surgical approach [GA and open (GAO), GA and laparoscopic (GAL), PVB and open (PVBO), and GA/PVB and open (GA/PVBO)]. Patients were excluded for missing data, self-catheterization, chronic opioid tolerance, and additional surgical procedures coinciding with hernia repair. Risk factors associated with the primary outcome of urinary retention were examined using logistic regression. RESULTS: PVBO (n = 136) had significantly lower odds than GAO of experiencing urinary retention (odds ratio 0.16; 95% CI 0.05-0.51); overall (P < .01), with 4.4% (n = 6) of the patients in the PVBO group having urinary retention versus 22.6% (n = 7) with GAO. Expressed as intravenous morphine equivalences, the PVBO group had the lowest median opioid use (5 mg), followed by GA, PVB, and open (7.5 mg); GAO 25 mg; and GAL 25 mg. Also, 30% (n = 41) of the PVBO group required no opioid analgesia in the postanesthesia care unit. CONCLUSIONS: PVBs as the primary anesthetic or an adjunct to GA is the preferred anesthetic technique for open inguinal hernia repair as it facilitates enhanced recovery after surgery by decreasing risk of urinary retention, opioid requirements, and length of stay.
PURPOSE:Inguinal hernia repair and general anesthesia (GA) are known risk factors for urinary retention. Paravertebral blocks (PVBs) have been utilized to facilitate enhanced recovery after surgery. We evaluate the benefit of incorporating PVBs into our anesthetic technique in a large cohort of ambulatory patients undergoing inguinal hernia repair. METHODS: Records of 619 adults scheduled for ambulatory inguinal hernia repair between 2010 and 2015 were reviewed and categorized based on anesthetic and surgical approach [GA and open (GAO), GA and laparoscopic (GAL), PVB and open (PVBO), and GA/PVB and open (GA/PVBO)]. Patients were excluded for missing data, self-catheterization, chronic opioid tolerance, and additional surgical procedures coinciding with hernia repair. Risk factors associated with the primary outcome of urinary retention were examined using logistic regression. RESULTS:PVBO (n = 136) had significantly lower odds than GAO of experiencing urinary retention (odds ratio 0.16; 95% CI 0.05-0.51); overall (P < .01), with 4.4% (n = 6) of the patients in the PVBO group having urinary retention versus 22.6% (n = 7) with GAO. Expressed as intravenous morphine equivalences, the PVBO group had the lowest median opioid use (5 mg), followed by GA, PVB, and open (7.5 mg); GAO 25 mg; and GAL 25 mg. Also, 30% (n = 41) of the PVBO group required no opioid analgesia in the postanesthesia care unit. CONCLUSIONS:PVBs as the primary anesthetic or an adjunct to GA is the preferred anesthetic technique for open inguinal hernia repair as it facilitates enhanced recovery after surgery by decreasing risk of urinary retention, opioid requirements, and length of stay.
Authors: Stephen M Klein; Ricardo Pietrobon; Karen C Nielsen; Susan M Steele; David S Warner; Joseph A Moylan; W Steve Eubanks; Roy A Greengrass Journal: Reg Anesth Pain Med Date: 2002 Sep-Oct Impact factor: 6.288
Authors: Admir Hadzic; Beklen Kerimoglu; Dan Loreio; Pelin Emine Karaca; Richard E Claudio; Marina Yufa; Ray Wedderburn; Alan C Santos; Daniel M Thys Journal: Anesth Analg Date: 2006-04 Impact factor: 5.108