The Comparison Of Local Anesthesia With Epidural Block Anesthesia In Tension-free Inguinal Hernia Repair

Inguinal hernia surgery is common, frequently-occurring disease. There is a higher rate of incidence in the infants ,young children and the elderly . According to statistics of hernia in the general population, the incidence is estimated at 3%, the ratio of men and women: 12:1, more than five million worldwide in patients with hernia of the implementation of a hernia repair. Is generally believed that the indirect inguinal hernia in children is a congenital malformation. And the elderly are often associated with chronic cough, dysuria, constipation, increased abdominal obesity , other chronic diseases and the growing recession in the Organization of the abdominal wall. Traditional methods of surgical hernia repair Bassini and beyond M c Vay, Halsted and Shouldice repair surgery, and they have a thread there is a tension, and at different levels suture anatomical shortcomings. With the "tension-free hernioplasty" put forward the concept of a hernia operation in line with the requirements of the modern (post-operative pain patch of light, shorter recovery time, recurrence rate is low and fewer complications) surgical approach "that is, X-ray repair surgery Lichtenstein "and" Plug filling tension-free repair operation "has been used more and more. Tension-free inguinal hernia repair has been developed in Europe and America as a standard procedure, the superiority of their treatment in our country has been the consensus of the majority of surgeons. However, due to the specificity of the conditions of our country, specifically, medical costs due to the reasons for tension-free inguinal hernia repair has not yet universal across the country, especially at the grass-roots hospitals and the majority of the rural areas, can accept the tension-free inguinal hernia repair the proportion of patients surgery is extremely low. How to reduce medical costs, has become the standard method of universal key. In addition to lower material costs, reduce the cost of anesthesia is also an aspect of utmost importance. On the anesthesia, the current is still mainly based on epidural anesthesia. Compared with traditional surgery, tension-free hernia repair surgery quicker and more convenient choice of anesthesia and therefore there is more room for rapid recovery after local anesthesia under the tension-free hernia repair possible. Therefore the application of local anesthesia can resolve this issue, explore a new way. This article is a response to this problem, I hope through the tension-free hernioplasty retrospective analysis of case-patients to sum up different ways of anesthesia, the treatment effect is statistically meaningless, whether or not as we expected: With the methods of local anesthesia improved local anesthesia tension-free inguinal hernia repair its advantages will become increasingly apparent, so that local anesthesia has become routine hernia anesthesia and promote tension-free hernioplasty to the development of ambulatory surgery.Objective: Comparison of local anesthesia and epidural anesthesia tension-free inguinal hernia repair results, summed up the tension-free inguinal hernia repair is more appropriate anesthesia, local anesthesia is better than expected epidural anesthesia, can be a tension-free hernioplasty conventional anesthesia way.Methods:Of our general surgery in January 2007 -July 2008 period , 55 cases of inguinal hernia repair in patients with tension-free study is divided into local anesthesia group (n = 25 cases) and epidural anesthesia group (n = 30 cases). Epidural anesthesia group: 29 cases of male, female 1, aged 21 to 85 years old, the average age of 63. 3±5. 98 years old, 27 cases hernia, direct hernia 3 cases, of which 25 cases of unilateral hernia, 5 cases of bilateral hernia .Local anesthesia group: 24 cases of male, female 1, aged 25 to 78 years old, the average age of 58. 88±5. 35 years old, 23 cases hernia, direct hernia 2 cases, of which 22 cases of unilateral hernia, 3 cases of bilateral hernia. Surgical results of the two groups had a subjective (including anesthesia and postoperative satisfaction rate in January will to the extent of re-operation patients) and objective (including record of operation time, postoperative urinary retention, postoperative wound pain, postoperative time to get out of bed, hospital costs and follow-up recurrence), there is a comparative study with them .Results:Statistical formula used to research the medical data processing, measurement data using t test, x2 test with count data. Detection level of a = 0.05. The results are as follows:(1)Subjective evaluation: local anesthesia and epidural anesthesia in patients with the two groups were satisfied with the overall satisfaction rate. In January after the wishes of the extent of re-operation patients: epidural anesthesia group, 25 patients (83.33%) indicated their willingness to accept the surgery; local anesthesia group, 24 patients (96%) indicated their willingness to accept the operation.(2)Objective evaluation: local anesthesia and epidural anesthesia in two groups of patients with incision infection, scrotal edema, subcutaneous hemorrhage, postoperative recurrence was no significant statistical difference, but the local anesthesia group in the operation time, postoperative urinary retention, after time to get out of bed, hospital costs were less than the epidural anesthesia group (P <0. 05).Conclusions:1. Local anesthesia and epidural anesthesia have the same satisfaction. The use of local anesthesia, to complete tension-free inguinal hernia repair a variety of surgical procedures, but requested more surgeon-rich clinical experience, be familiar with the anatomical structure of the groin area. Choice of anesthesia should be accurate, the master scope and depth of anesthesia.2. Local anesthesia tension-free inguinal hernia repair, preoperative preparation can be reduced to reduce the cost of epidural anesthesia , to reduce post-operative complications occurred when the costs incurred to reduce the length of stay in hospital, but also can significantly reduce the total treatment costs. Local technology can be a tension-free inguinal hernia repair conventional anesthesia.3. But not easy to respond to the hernia, a huge hernia and recurrent hernia patients, and made a local injection treatment and the patients with obesity, you can choose to epidural anesthesia or general anesthesia.