Spinal or local anesthesia in Lichtenstein hernia repair - A randomized controlled trial

Background: With established protocols lacking, the choice of anesthetic technique remains arbitrary in inguinal hernia repair. Well-designed studies in this subject are important because of the gap or discrepancy between available scientific evidence and clinical practice. Methods: Between August 2004 and June 2006, a multicenter prospective clinical trial was performed in which 100 patients with unilateral primary inguinal hernia were randomized to spinal or local anesthesia. Clinical examination took place within 2 weeks postoperatively and at 3 months in the outpatient clinic. Results: Analysis of postoperative visual analogue scale scores showed that patients operated under local anesthesia had significant less pain shortly after surgery (P = 0.021). Significantly more urinary retention (P < 0.001) and more overnight admissions (P = 0.004) occurred after spinal anesthesia. Total operating time is significantly shorter in the local anesthesia group (P < 0.001). No significant differences were found between the 2 groups with respect to the activities of daily life and quality of life. Conclusions: Our study provides evidence that local anesthesia is superior to spinal anesthesia in inguinal hernia repair. Local anesthesia in primary, inguinal hernia repairs should be the method of choice.