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  • Title: Subarachnoid anesthesia vs monitored anesthesia care for outpatient unilateral inguinal herniorrhaphy.
    Author: Poli M, Biscione R, Bacchilega I, Saravo L, Trombetti P, Amelio G, Rossi G.
    Journal: Minerva Anestesiol; 2009; 75(7-8):435-42. PubMed ID: 19571779.
    Abstract:
    AIM: Inguinal herniorrhaphy is one of the most commonly performed surgical procedures in a same-day surgery setting. The prerequisite of having to discharge the surgical outpatient on the same day has an influence on the choice of the anesthetic technique. METHODS: A randomized clinical trial was performed on 100 outpatients; 50 patients were enrolled in the subarachnoid anesthesia (SA) group and 50 patients in the monitored anesthesia care (MAC) group. Patients in the MAC group received local anesthesia plus target-controlled infusion propofol (LA+TCI). SA was performed using 7.5 mg 0.5% hyperbaric bupivacaine according to the selective technique. In the LA+TCI group, LA was performed with 20 mL 1% mepivacaine + 10 mL 1% ropivacaine; IV propofol sedation using TCI according to Schnider was used to obtain a Ramsay scale response of 4-5. Transferability from the operating room was evaluated based on an Aldrete score > or =9; ability to discharge from the health facility was evaluated based on a Post-Anesthesia Discharge Scoring System (PADSS) > or =9. RESULTS: Of the 100 total patients enrolled, five drop-outs were recorded in the SA group. By comparing the LA+TCI and SA groups, it was determined that the time to an Aldrete > or =9 score from the end of the procedure was 25+/-27 vs 34+/-54 min (P=0.330); the time to a PADSS 9 score was 113+/-58 vs 181+/-65 min (P<0.001); actual discharge occurred after 236+/-83 vs 289+/-78 min (P<0.01). CONCLUSIONS: LA+TCI was shown to be more effective than selective SA at low doses in terms of shorter time to recovery after unilateral inguinal herniorrhaphy procedures.
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