Anestesia local vs anestesia espinal en hernioplastia inguinal: comparación de efecto anestésico postoperatorio

SUMMARY Published reports suggest that local anesthesia before tissue injury blocks afferent pathways and modulate pain severity, favoring a postoperative course with less analgesia requirements. We evaluated and compared the postoperative analgesic effect and patients acceptance of the anesthetic technique using local anesthesia versus spinal anesthesia. The series is composed of 32 consecutive patients, ASA I-II admitted for unilateral primary inguinal hernia repair. Surgical technique consisted in anatomical repair of the inguinal floor with placement of a tension-free mesh. The type of anesthesia was assigned randomly. Group A: local anesthesia with bupivacaine (up to 2 mg per kg) and lidocaine (up to 4 mg per kg), administered by the surgeon; group B spinal anesthesia in L2-L3, with isobarus 0,75% bupivacaine, 10 mg plus 25 micrograms of fentanil. The patients were instructed to indicate the pain severity both at rest and during movements (coughing or sitting up) using an analog verbal scale with values from 1 to 10. Pain was measured at 4, 8, 12, and 24 hours following the procedure. The group who received local anesthesia reported less pain compared to the group with spinal anesthesia at 8, 12 and 24 hours. The difference reached statistical significance, especially for pain during active movements.