Article on post op management of inguianl hernia surgery via epidural
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Background
The extension of indications for procedures in a Day Surgery (DS) setting has led to changes in the anesthetic and surgical treatment of Inguinal Hernias (IH). According to the recommendations of the European Hernia Society, the treatment of IH in DS units should be performed under Monitored Anesthesia Care (MAC).
Patients and methods
960 patients underwent IH repairs over a period of 24 months. The patients were randomly divided into two groups: R (remifentanil) and F (fentanyl); the group F was considered as a control group. The exclusion criteria in both group were: morbid obesity (BMI>40 or BMI>35 in association with high blood pressure or diabetes); coagulopathy; OSAS (obstructive sleep apnea syndrome) with AHI >10; cardiovascular, respiratory, renal, hepatic or metabolic disease; history of substances abuse; GERD-related esophagitis (gastro-esophageal reflux disease); chronic analgesic use; allergy to local anesthetic and ASA>III. Patients reported their level of pain on a verbal numeric scale (VNS), with scores ranging from 0 to 10. For each patient systolic and diastolic blood pressure (SBP and DBP), mean arterial pressure (MAP), heart rate (HR) and peripheral oxygen saturation (SpO2) were recorded. The results are presented as the mean value ± standard deviations; statistical analysis was performed using Student’s t-test.
Results
Amongst the 960 procedures, complications or side effects related to the anesthetic techniques didn’t occur; no procedure-related complications requiring mechanical ventilation support were reported. Our research focused on evaluating remifentanil effectiveness in pain control and its impact on hemodynamic stability and respiratory function. There was a significant difference between the two groups with regard to the VNS.
Conclusions
Remifentanil, is an excellent drug for pain control during intra-operative procedures, that allows an optimal hemodynamic stability for IH repairs in a DS setting, due to its pharmacokinetic and pharmacodynamic properties and few adverse effects.
Keywords: Inguinal hernia, Monitored Anesthesia Care, Remifentanil
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Introduction
The extension of indications for procedures in a day surgery setting (DS) has determined a large number of changes in the anesthesiological management and surgical treatment of Inguinal Hernias (IH), since the European Hernia Society confirmed that the treatment of IH in DS is safe, valid and cost-effective, independently of the type of surgical hernia repair (1). Furthermore, elderly ASA III patients are also suitable for this procedure, after an accurate assessment of individual health conditions (2). As a matter of fact, DS should be considered for all types of patients after rating individual characteristics and comorbidities (3–6). According to the European Hernia Society recommendations, the treatment of IH in DS should be performed under Monitored Anesthesia Care (MAC). This technique is a planned procedure during which the patients undergo local anesthesia together with analgesic and sedative procedures, in order to achieve a safe sedation together with anxiety and pain control (7, 8). In our experience, MAC has been done by analgesia and sedation in addition to local anesthesia.
Our research focused on opioid drugs characterized by high efficiency and ultra-fast recovery, since the context-sensitive half-time (CSHT) is very short: approximately 3 minutes (9, 10). Moreover, MAC allows the patients to be discharged very soon.
This study’s purpose was to determine the efficacy of remifentanil and its analgesic role in the intraoperative pain management during IH repair, performed in a DS regimen. We evaluated the effect of the drug on intra-operative pain control, safety of handling and timing of discharge.