Our Summary

This research paper reviews the use of spinal anesthesia (numbing from the waist down) in a specific type of hernia repair surgery, known as total extraperitoneal inguinal hernia repair (TEP). Traditionally, this surgery is performed under general anesthesia (where the patient is completely unconscious), but some doctors have tried using spinal anesthesia instead, especially for patients who may be at risk from general anesthesia.

The researchers looked at eight studies involving 1,311 patients (mostly men) who had this hernia repair surgery under spinal anesthesia. They found that the most common drug used for the anesthesia was bupivacaine 0.5%. Very few patients (0.76%) needed to be switched to general anesthesia during the surgery because the spinal anesthesia didn’t work properly, and only a tiny fraction (0.2%) had to have their surgery switched to an open procedure.

The most common issue during the surgery was low blood pressure, but this could be effectively treated. After surgery, fluid build-up at the surgical site was the most common complication. On average, patients stayed in the hospital for about a day and a half.

In conclusion, the researchers suggest that spinal anesthesia could be a safe and practical option for this type of hernia repair surgery. However, they call for more thorough and well-designed studies to confirm this and to understand the pros and cons of spinal anesthesia in this context for different types of patients.

FAQs

  1. What is the most common drug used for spinal anesthesia in total extraperitoneal inguinal hernia repair (TEP)?
  2. What were the most common complications during and after the surgery under spinal anesthesia?
  3. How effective is spinal anesthesia compared to general anesthesia in total extraperitoneal inguinal hernia repair (TEP)?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic hernia repair is to discuss the option of using spinal anesthesia with their healthcare provider. Spinal anesthesia may be a safe and effective alternative to general anesthesia for some patients undergoing this type of surgery. It is important to have an open and honest conversation with your doctor about your medical history and any concerns you may have about the anesthesia options available to you.

Suitable For

Typically, patients who may be at risk from general anesthesia or who have contraindications to general anesthesia are recommended for laparoscopic hernia repair using spinal anesthesia. This may include patients with underlying health conditions that make general anesthesia risky, older patients, or patients with a history of adverse reactions to general anesthesia. It is important for each patient to be evaluated individually by their healthcare provider to determine the most appropriate anesthesia option for their specific situation.

Timeline

Before laparoscopic hernia repair:

  1. Patient is diagnosed with a hernia and consults with a surgeon.
  2. Pre-operative tests and evaluations are conducted to assess the patient’s overall health and suitability for surgery.
  3. Patient receives instructions on pre-operative preparation, such as fasting and medication adjustments.
  4. Patient arrives at the hospital or surgical center on the day of surgery.
  5. Anesthesia is administered, either general anesthesia or spinal anesthesia.

After laparoscopic hernia repair:

  1. Surgery is performed using minimally invasive techniques, with small incisions and a camera-guided approach.
  2. Hernia is repaired using mesh to strengthen the abdominal wall.
  3. Patient wakes up from anesthesia in the recovery room.
  4. Patient may experience pain, discomfort, and swelling at the surgical site.
  5. Patient is monitored for any potential complications, such as bleeding or infection.
  6. Patient is discharged from the hospital typically within a day or two after surgery.
  7. Patient receives instructions on post-operative care, including pain management and activity restrictions.
  8. Follow-up appointments are scheduled to monitor recovery and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laparoscopic hernia repair using spinal anesthesia could include:

  1. What are the potential benefits of using spinal anesthesia for my hernia repair surgery?
  2. What are the risks or potential complications associated with spinal anesthesia compared to general anesthesia?
  3. How experienced are you and your team in performing hernia repair surgery using spinal anesthesia?
  4. What will the recovery process be like after surgery with spinal anesthesia?
  5. Are there any specific guidelines or restrictions I should follow before or after surgery if I choose spinal anesthesia?
  6. How likely is it that I may need to be switched to general anesthesia during the surgery?
  7. What are the success rates and outcomes of hernia repair surgery using spinal anesthesia compared to general anesthesia?
  8. Are there any specific factors about my health or medical history that would make me a good or poor candidate for spinal anesthesia in this surgery?
  9. How will pain management be handled during and after the surgery if I choose spinal anesthesia?
  10. Are there any additional risks or considerations I should be aware of if I choose spinal anesthesia for my hernia repair surgery?

Reference

Authors: Baloyiannis I, Perivoliotis K, Sarakatsianou C, Tzovaras G. Journal: Surg Endosc. 2018 May;32(5):2184-2192. doi: 10.1007/s00464-018-6083-6. Epub 2018 Feb 5. PMID: 29404730