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Departments of Anesthesiology and Pain Management,
*University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, and
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Address correspondence to Paul F. White, MD, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5161 Harry Hines Blvd., F 2.208, Dallas, TX 75235-9068. Address e-mail to paul.white{at}utsouthwestern.edu
The use of an ilioinguinal-hypogastric nerve block (IHNB) as part of a monitored anesthesia care (MAC) technique has been associated with a rapid recovery profile for outpatients undergoing inguinal herniorrhaphy procedures. This study was designed to compare the cost-effectiveness of an IHNB-MAC technique with standardized general and spinal anesthetics techniques for inguinal herniorrhaphy in the ambulatory setting. We randomly assigned 81 consenting outpatients to receive IHNB-MAC, general anesthesia, or spinal anesthesia. We evaluated recovery times, 24-h postoperative side effects and associated incremental costs. Compared with general and spinal anesthesia, patients receiving IHNB-MAC had the shortest time-to-home readiness (133 ± 68 min vs 171 ± 40 and 280 ± 83 min), lowest pain score at discharge (15 ± 14 mm vs 39 ± 28 and 34 ± 32 mm), and highest satisfaction at 24-h follow-up (75% vs 36% and 64%). The total anesthetic costs were also the least in the IHNB-MAC group ($132.73 ± 33.80 vs $172.67 ± 29.82 and $164.97 ± 31.03). We concluded that IHNB-MAC is the most cost-effective anesthetic technique for outpatients undergoing unilateral inguinal herniorrhaphy with respect to speed of recovery, patient comfort, and associated incremental costs.
Implications: Local anesthesia with propofol sedation for inguinal hernia repair was associated with a faster recovery, higher patient satisfaction, and lower costs compared with general and spinal anesthesia.
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