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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2009 July-August;75(7-8):435-42
Subarachnoid anesthesia vs monitored anesthesia care for outpatient unilateral inguinal herniorrhaphy
Poli M. 1, Biscione R. 1, Bacchilega I. 1, Saravo L. 1, Trombetti P. 1, Amelio G. 2, Rossi G. 1
1 Department of Anesthesia, Intensive Care Unit and Antalgic Therapy, Civile Nuovo Hospital, Imola, Italy;
2 Manager of Day Surgery Centre of Castel San Pietro Terme, General Surgery Department, Civile Nuovo Hospital, Imola, Italy
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 ≥9; ability to discharge from the health facility was evaluated based on a Post-Anesthesia Discharge Scoring System (PADSS) ≥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 ≥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).
Conclusion. 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.