Analysis Of The Influence Of Anesthesia On Chronic Pain And Recurrence After Open Inguinal Hernia Repair And The Risk Factors Of Chronic Pain And Recurrence

Objective:The purpose of this study was to analyze the effects of different anesthesia methods on chronic pain and recurrence after open inguinal hernia repair and related risk factors,and to explore the reliability of open inguinal hernia repair under local anesthesia.Materials and Methods:This study continuously included 666 patients who underwent open tension inguinal hernia repair at the First Hospital of Lanzhou University from January 01,2014 to December 31,2018(all operations were performed by senior doctors and above in our hospital).According to the inclusion and exclusion criteria,a total of 653 cases entered this study.There were 198 cases in the local anesthesia group and 455 cases in the spinal anesthesia group.In the local anesthesia group,there were 191 males and 7 females;13 cases of compound hernia,2 cases of incarcerated hernia,123 cases of indirect hernia,and 60 cases of direct hernia;including 51 cases of Lichtenstein operation and 147 cases of preperitoneal space repair;emergency department 6 cases of surgery;13 cases of chronic groin pain and 3 cases of recurrence.In the spinal canal anesthesia group,there were 455 cases,including 416 males and 39 females;28 cases of compound hernia,19 cases of incarcerated hernia,181 cases of indirect hernia,and 127 cases of direct hernia;252 cases of Lichtenstein operation and preperitoneal space repair 203cases;24 cases of emergency surgery;39 cases of chronic groin pain,7 cases of recurrence.The clinical data of all patients including age,gender,body mass index and other general information and surgical methods,anesthesia methods,etc.were recorded,followed by telephone and outpatient combination,follow-up time was1~5 years.The clinical data,chronic groin pain and recurrence indexes of the two groups were statistically analyzed.Results:The average age of the patients in the local anesthesia group was 67.91±13.42 years,and the average age of the patients in the spinal anesthesia group was55.85±16.73 years.The age of the patients in the local anesthesia group was greater than that in the spinal anesthesia group.The difference was statistically significant(p<0.05).There were 7 female patients in the local anesthesia group,accounting for3.67%,and 39 female patients in the spinal anesthesia group,accounting for 9.38%.The difference in gender composition between the two groups was statistically significant(p>0.05).The average body mass index of the patients in the local anesthesia group was 23.03±3.51 kg/m~2,and the average body mass index of the patients in the spinal canal anesthesia group was 23.12±3.22 kg/m~2.There was no statistically significant difference in hernia type between the local anesthesia group and the spinal canal anesthesia group.In the local anesthesia group,51 patients underwent Lichtenstein operation,147 patients underwent anterior peritoneal space repair,252 patients underwent Lichtenstein operation in the spinal anesthesia group,and 203 patients underwent anterior peritoneal space repair(p<0.001).There was no statistical difference in the proportion of emergency surgery between the two groups.There was no significant difference in chronic groin pain between the two groups(χ~2=0.757,p=0.384),and there was no statistical difference between the two groups(χ~2=0.000,p=0.982).Multivariate regression analysis showed that body mass index and age were the main factors affecting chronic groin pain(p<0.001),and the greater the body mass index,the higher the incidence of chronic groin pain(OR=1.249).Compared with the patients in the age group of 40 to 65 years,the risk of chronic groin pain was higher than that in the patients in the age group of 40 to 65years(OR=6.355,95%CI=2.367~17.063).The age group had a higher risk of chronic groin pain(OR=3.025,95%CI=1.262~7.254).The anesthesia method,gender,hernia type,emergency operation and operation method had no significant effect on the occurrence of chronic groin pain(p>0.05).The recurrence rate after direct hernia surgery was significantly higher than that of oblique hernia(p=0.010,p<0.05,OR=0.144),and body mass index was the influencing factor for hernia recurrence(p=0.018,p<0.05,OR=0.141).Conclusion:Different anesthesia methods have no effect on chronic groin pain and postoperative recurrence after open inguinal hernia repair.Body mass index and age are risk factors for postoperative chronic inguinal pain,and direct hernia and body mass index are risk factors for relapse.Open inguinal hernia repair under local anesthesia is safe,reliable,and worthy of promotion.