Local anaesthetic vs. general anaesthetic for inguinal hernia repair: Systematic review and meta-analysis

Objective: Whilst local anaesthesia (LA) has been preferred to general anaesthesia in specialist centres, this practice has not been reflected in general hospitals, where most operations occur. This meta-analysis will analyse differences in outcome between the two techniques from previous studies conducted in general hospitals to determine the evidence for practice in this setting. Materials and methods: A search of PubMed, Medline and Embase was undertaken, as well as a search for UK presentations, limited to English language trials published since 1966. This identified five randomised controlled trials and a total of 895 patients for meta-analysis. Only outcomes reported in at least three studies were included. Results: The number of patients experiencing postoperative nausea was significantly reduced in the LA group. The time taken to return to normal social activities was also significantly reduced in the LA group, by a period of 1 day. There were no differences in urinary retention rates or return to work. The time in theatre and the operative time were not altered significantly by differing anaesthetic techniques. Conclusions: Meta-analysis of the five trials comparing local and general anaesthesia for inguinal hernia repair fails to confirm the wide-ranging benefits reported by the individual studies. Local anaesthetic reduces nausea and accelerates return to normal activities following open inguinal hernia repair. The benefit of LA is sufficiently small that its use should be dictated by patient and clinician preference.