European Journal of Cardiovascular Medicine

Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide, with an estimated incidence of 27 per 100,000 population annually (1). It is predominantly performed using either open or laparoscopic techniques, with open repair remaining the most common approach, especially in low-resource settings (2). The choice of anesthesia for inguinal hernia repair significantly influences the overall success of the procedure, recovery, and patient satisfaction.

Spinal anesthesia (SA) and local anesthesia (LA) are two commonly employed techniques for inguinal hernia repair. Spinal anesthesia involves injecting local anesthetic agents into the subarachnoid space, resulting in a temporary and reversible loss of sensation and motor function in the lower part of the body (3). It provides effective analgesia during the procedure; however, it is associated with side effects such as hypotension, urinary retention, and prolonged recovery time (4,5).

In contrast, local anesthesia, which involves the infiltration of anesthetic agents directly into the surgical site, has gained popularity due to its safety profile, rapid recovery, and minimal systemic complications (6). Furthermore, local anesthesia allows patients to remain conscious during the procedure, contributing to enhanced postoperative recovery and shorter hospital stays (7). Previous studies have demonstrated that local anesthesia offers comparable analgesic efficacy to spinal anesthesia with fewer adverse effects (8).

Comparative studies between spinal anesthesia and local anesthesia have reported mixed results, with some favoring spinal anesthesia for its superior intraoperative pain control, while others emphasize the benefits of local anesthesia in terms of rapid recovery and reduced complications (9,10). However, there remains a need for more robust clinical evidence comparing these two techniques, particularly in relation to postoperative pain, patient satisfaction, and complication rates.

The present study aims to compare the efficacy, safety, and patient satisfaction associated with spinal anesthesia and local anesthesia in patients undergoing inguinal hernia repair. The findings from this study could contribute to optimizing anesthesia choice for improved surgical outcomes and patient-centered care.

A total of 120 adult patients, aged between 18 to 65 years, scheduled for elective inguinal hernia repair were enrolled in the study. Patients were randomly assigned into two groups:

• Group SA (Spinal Anesthesia): Patients receiving spinal anesthesia (n = 60).
• Group LA (Local Anesthesia): Patients receiving local anesthesia (n = 60).
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Inclusion Criteria:

• Age between 18 to 65 years.
• Patients undergoing elective unilateral inguinal hernia repair.
• American Society of Anesthesiologists (ASA) classification I–II.
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Exclusion Criteria:

• Patients with a history of coagulation disorders, severe cardiovascular or respiratory diseases.
• Allergic reactions to local anesthetics.
• Patients with recurrent or complicated hernias.
• Refusal to participate in the study.

Randomization and Blinding:

Patients were randomly assigned to either group using a computer-generated randomization table. Blinding was not possible due to the nature of the anesthesia techniques. However, postoperative evaluations were performed by an independent observer unaware of the group allocation.

Anesthesia Technique:

Spinal Anesthesia (Group SA): Patients in this group received spinal anesthesia using 0.5% bupivacaine (15 mg) injected into the subarachnoid space at the L3-L4 intervertebral space under strict aseptic conditions. Hemodynamic parameters were continuously monitored throughout the procedure.

Local Anesthesia (Group LA): Patients in this group received local infiltration anesthesia using 1% lidocaine with epinephrine (1:200,000), injected along the line of the planned incision and around the hernia sac. Additional local anesthetic was administered as needed during the procedure to maintain adequate pain control.

Data Collection:

The following parameters were recorded and analyzed:

• Intraoperative Pain Scores: Measured using a Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst possible pain).
• Postoperative Pain Scores: Assessed at 1, 6, and 24 hours post-surgery using the VAS.
• Recovery Time: Defined as the duration from the end of the procedure until the patient achieved ambulation.
• Complications: Any adverse events such as hypotension, nausea, vomiting, urinary retention, or local site infection.
• Patient Satisfaction: Evaluated using a structured questionnaire on a scale of 0 to 100, with higher scores indicating greater satisfaction.

Statistical Analysis:

Data were analyzed using SPSS software version 25.0. Continuous variables were expressed as mean ± standard deviation and compared using the Student’s t-test. Categorical variables were presented as frequencies and percentages, and comparisons were made using the Chi-square test. A p-value of <0.05 was considered statistically significant.

A total of 120 patients were included in the study and randomized into two groups: Spinal Anesthesia (Group SA, n = 60) and Local Anesthesia (Group LA, n = 60). There were no significant differences in demographic characteristics between the groups (p > 0.05).

Patient Demographics and Baseline Characteristics

Table 1 presents the demographic data and baseline characteristics of the study participants. Both groups were comparable concerning age, gender, weight, and American Society of Anesthesiologists (ASA) classification (Table 1).

Table 1: Demographic Characteristics of Patients

Intraoperative Pain Scores

The mean intraoperative pain scores, measured using the Visual Analog Scale (VAS), were significantly lower in the spinal anesthesia group compared to the local anesthesia group (p < 0.001) (Table 2).

Table 2: Intraoperative Pain Scores (VAS)

Postoperative Pain Scores

Postoperative pain scores assessed at 1-, 6-, and 24-hours post-surgery were significantly lower in the spinal anesthesia group compared to the local anesthesia group, particularly during the early postoperative period (Table 3).

Table 3: Postoperative Pain Scores (VAS)

Recovery Time and Complications

The mean recovery time was significantly shorter in the local anesthesia group compared to the spinal anesthesia group (p < 0.001). Additionally, complications such as hypotension and urinary retention were more frequent in the spinal anesthesia group (Table 4).

Table 4: Recovery Time and Complications

Patient Satisfaction

Patient satisfaction scores were significantly higher in the local anesthesia group compared to the spinal anesthesia group (p < 0.05) (Table 5).

Table 5: Patient Satisfaction Scores

The results clearly indicate that local anesthesia provides faster recovery and higher patient satisfaction compared to spinal anesthesia, although spinal anesthesia offers better intraoperative pain control.

The findings of this study demonstrate significant differences between spinal anesthesia (SA) and local anesthesia (LA) in terms of intraoperative pain control, recovery time, complications, and patient satisfaction for inguinal hernia repair. Each technique has its own advantages and limitations, which should be considered while choosing the appropriate anesthesia approach.

Intraoperative pain control was found to be significantly better in the spinal anesthesia group as indicated by the lower Visual Analog Scale (VAS) scores compared to the local anesthesia group (p < 0.001). This result aligns with previous studies reporting superior intraoperative analgesia with spinal anesthesia due to the blockade of nerve transmission at the spinal level (1,2). However, the better pain control associated with spinal anesthesia comes at the cost of increased complications, such as hypotension and urinary retention, which were reported in 11.6% and 8.3% of patients, respectively (Table 4). Such complications are commonly associated with spinal anesthesia, particularly when higher doses of local anesthetics are used (3,4).

In contrast, local anesthesia demonstrated significant advantages in terms of faster recovery time and higher patient satisfaction. The mean recovery time was considerably shorter in the local anesthesia group (45 ± 10 minutes) compared to the spinal anesthesia group (120 ± 15 minutes) (p < 0.001). This finding is consistent with previous studies highlighting the rapid recovery associated with local anesthesia, which enables earlier ambulation and discharge (5,6). Furthermore, the absence of complications such as hypotension and urinary retention in the local anesthesia group emphasizes its safety and efficacy (7,8).

Patient satisfaction was notably higher in the local anesthesia group (90%) compared to the spinal anesthesia group (75%), suggesting that patients generally prefer anesthesia techniques that facilitate faster recovery and minimize postoperative discomfort (9,10). Moreover, local anesthesia allows patients to remain conscious and communicate during the procedure, contributing to enhanced patient experience and satisfaction (11).

Previous studies have also highlighted the economic advantages of using local anesthesia for hernia repair. Reduced hospital stay, fewer postoperative complications, and faster recovery contribute to overall cost-effectiveness, making it a preferred choice in outpatient settings (12,13). Nonetheless, local anesthesia may not be suitable for all patients, particularly those with high anxiety levels or those requiring extensive hernia repair (14).

Despite the advantages of local anesthesia, it was associated with higher intraoperative pain scores compared to spinal anesthesia. This limitation could be addressed by using a combination of local anesthetic agents or by supplementing with mild sedation to enhance patient comfort during the procedure (15).

The findings of this study are consistent with previous literature indicating that local anesthesia is a viable alternative to spinal anesthesia for inguinal hernia repair, particularly in terms of patient satisfaction and rapid recovery (1,2,5,6,10). However, spinal anesthesia remains a preferred choice in cases where superior intraoperative pain control is desired (3,4).

Limitations

This study has certain limitations. Firstly, the lack of blinding could have introduced bias in the assessment of patient satisfaction. Secondly, the study was conducted at a single centre with a relatively small sample size, limiting the generalizability of the findings. Future studies with larger sample sizes and multicentre designs are recommended to validate these results.

Local anesthesia provides faster recovery, fewer complications, and higher patient satisfaction compared to spinal anesthesia for inguinal hernia repair. However, spinal anesthesia offers better intraoperative pain control. The choice of anesthesia should be tailored to individual patient needs, surgical requirements, and clinical setting.

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