• Pertti Pere, Jukka Harju, Pekka Kairaluoma, Veikko Remes, Päivi Turunen, and Per H Rosenberg.
• Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine; Day-Surgery Center at Surgical Hospital, Helsinki University Central Hospital, PO Box 263, 00029, HUS, Helsinki, Finland. Electronic address: pertti.pere@hus.fi.
• J Clin Anesth. 2016 Nov 1; 34: 166-75.

Study ObjectiveComparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TIVA patients.DesignRandomized, prospective trial.SettingUniversity hospital day-surgery center.Patients156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy.InterventionsPatients were randomized to either LAI (lidocaine+ropivacaine), SPIN (bupivacaine+fentanyl) or TIVA (propofol+remifentanil). Perioperative Ringer infusion was 1.5mL/h. Urinary bladder was scanned before and after surgery. Interviews were performed on postoperative days 1, 7 and 90.MeasurementsDuration of surgery, duration of the patients' stay in the operating room and time until their readiness for discharge home. Patient satisfaction and adverse effects were registered.Main ResultsSurgery lasted longer in LAI group (median 40min) than in SPIN group (35min) (P=.003) and TIVA group (33min) (P<.001). Although surgery was shortest in TIVA group, TIVA patients stayed longer in the operating room than LAI patients (P=.001). Time until readiness for discharge was shorter in LAI group (93min) than in TIVA (147min) and SPIN (190min) groups (P<.001). Supplementary lidocaine infiltration was given to 32 LAI patients, and IV fentanyl to 29 LAI and 4 SPIN patients. Ephedrine was required in 34 TIVA, 5 LAI and 5 SPIN patients. One SPIN and three LAI patients had to be given TIVA and another SPIN patient LAI to complete the operations. Urinary retention was absent. Discomfort in the scar (26%) three months postoperatively was not anesthesia-related.ConclusionsLogistically, LAI was superior because of the fastest recovery postoperatively. The anesthetic techniques were adequate for surgery in all but a few LAI and SPIN patients. Lack of urinary retention was probably related to the small IV infusion volumes.Copyright © 2016 Elsevier Inc. All rights reserved.

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