Comparison between Monitored Anesthesia Care Combine with Fentanyl under Ilioinguinal and Iliohypogastric Nerve Block and Spinal Anesthesia for Inguinal Herniorrhaphy in Saraburi Hospital

Main Article Content

Pollapat Suleesathira


Background and Objective: The purpose of this study was to compare the outcomes of spinal anesthesia and ilioinguinal-hypogastric nerve block (IHNB) combine with infusion of fentanyl with monitored anesthesia care (MAC) for inguinal herniorrhaphy in Saraburi hospital.

Methods: A prospective, randomized controlled trial was conducted for elective inguinal herniorrhaphy. Forty patients were assigned equally into spinal anesthesia group (Group S) and IHNB with MAC group (Group M). In Group M, fentanyl was injected 2 mcg./kg. intravenously 5 minutes before IHNB was performed and then  infused continuously until the operation was over. Two groups were compared to assess hemodynamic values, oxygen saturation, observer’s assessment of alertness/sedation scale (OAA/S), visual analogue scale (VAS) and patients' and surgeon's satisfaction. Ephedrine administration,urinary retention and postoperative nausea vomiting were observed.

Results: The systolic, diastolic blood pressure and heart rate of Group S was significantly lower than Group M. Ephedrine was administered in Group S significantly higher than Group M. OAA/S, oxygen saturation and respiratory rate weren’t significantly different between the two groups. VAS in the recovery room were higher in Group M (p =0.001). VAS at the ward weren’t significantly different between the two groups. Patient’s satisfaction scores were higher in Group M (p=0.001) but surgeon's satisfaction scores were higher in Group S (p =0.005). The number of the patients who suffered from urinary retention,  postoperative nausea vomiting weren’t significantly different between the two groups.

Conclusion: IHNB under MAC combine with fentanyl is safe for elective inguinal herniorrhaphy. This approach can be applied for outpatient surgeries.


Article Details

Original Articles


1. Nordin P, Zetterstrom H, Gunnarsson U, Nilsson E. Local, regional, or general anaesthesia in groin hernia repair:multicenter randomised trial. Lancet 2003; 362(9387): 853-8.
2. Nordin P, Hernell H, Unosson M, Gunnarsson U, Nilsson E. Type of anaesthesia and patient acceptance in groin hernia repair: a multicenter randomised trial. Hernia 2004; 8: 220-5.
3. Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA,Domino KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology 2006; 104: 228-34.
4. Amid PK, Shulman AG, Lichtenstein IL. Local anesthesia for inguinal hernia repair step-by-step procedure. Ann Surg 1994; 220: 735–7.
5. Kulacoglu H, Ergul Z, Esmer AF, Sen T, Akkaya T, Elhan A. Percutaneous ilioinguinal-iliohypogastric nerve block or step-by-step local infiltration anesthesia for inguinal hernia repair: what cadaveric dissection says. J Korean Surg Soc 2011; 81: 408–13.
6. Fukuda K. Opioid Analgesics. In: Miller RD, editors. Miller's Anesthesia. ed 8.Philadelphia: Churchill Livingstone, 2018: 894.
7. Poli M, Biscione R, Bacchilega I, Saravo L, Trombetti P, Amelio G, et al. Subarachnoid anesthesia vs monitored anesthesia care for outpatient unilateral inguinal herniorrhaphy. Minerva Anestesiol 2009; 75(7-8): 435-42.
8. Li S, Coloma M, White PF, Watcha MF, Chiu JW, Li H, et al. Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery. Anesthesiology 2000; 93: 1225-30.
9. Avramov MN, Smith I, White PF .Interactions between midazolam and remifentanil during monitored anesthesia care. Anesthesiology 1996; 85: 1283-9.
10. Bailey PL, Pace NL, Ashburn MA, Moll JW, East KA, Stanley TH. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990; 73: 826-30.
11. Nieuwenhuijs DJ, Olofsen E, Romberg RR, Sarton E, Ward D, Engbers F, et al. Response surface modeling of remifentanil-propofol interaction on cardiorespiratory control and bispectral index. Anesthesiology 2003; 98: 312-22.
12. Song D, Greilich NB, White PF, Watcha MF, Tongier WK. Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphy. AnesthAnalg 2000; 91: 876-81.
13. Zacny JP, Lichtor JL, Zaragoza JG, de Wit H. Subjective and behavioral responses to intravenous fentanyl in healthy volunteers. Psychopharmacology (Berl) 1992; 107(2-3): 319-26.
14. Cathelin M, Vignes R, Malki A, Viars P. Comparison between the side-effects of fentanyl and morphine in conscious man. Anesth Analg (Paris) 1980; 37(5-6): 265-73.