有研究者認為區域性麻醉相較於全身麻醉，更有利於疝修補術患者術後康復。
既然局麻好，為啥還要選擇全麻或椎管內麻醉呢？歡迎留言交流！
在
Am J Surg
雜誌上發表一篇評論，標題為《腹股溝疝修補術是區域性麻醉還是全身麻醉？》
也認為局麻有優勢，但沒給出確切的證據。
原文譯文，供參考！
腹股溝疝修補術是區域性麻醉還是全身麻醉？
許多回顧性研究的結果，甚至是來自前瞻性資料庫的結果，由於與此類研究相關的固有偏見，常常受到批評。然而，考慮到從退伍軍人事務部手術質量改進計劃報告中分析的患者數量，這些想法可以被安全地拋棄。在該報告中，近100000名患者中有23%在10年期間使用區域性麻醉（LA）進行了疝修補術或疝成形術。
這些患者術後在康復室的時間明顯減少，術後併發症也明顯減少。
許多外科醫生，尤其是受訓者，可能不瞭解在洛杉磯進行修復的好處。與使用昂貴的機器人相比，這個概念並不新鮮！
LA允許在非臥床環境下快速活動，並且沒有術後泌尿系統問題。
然而，外科醫生確實需要一個“輕”的觸控，注意這個敏感區域的細節是至關重要的。對於較年輕的健康患者，在LA下進行修補顯然是不必要的，但由於疝修補術應被視為門診手術，因此所選擇的麻醉劑必須在該情況下表現良好。
LA修復是相對不健康患者的理想方法，也是老年患者的重要選擇，無論他們是否虛弱。
在修補腹股溝疝或股疝時，尤其是考慮到我們都被要求安全管理的老齡化人口，它是外科醫生裝備的一個重要組成部分。正如本文所暗示的，它可能沒有得到足夠的使用。為什麼會這樣？在給藥的學習曲線中，要達到充分和舒適的鎮痛可能有點困難。為此，我們已向我們的住院醫生傳授了“如何進行”的步驟，同時讓較年輕的健康患者在全身麻醉下進行修復。使用0。5%布比卡因和1%利多卡因與1：200000腎上腺素等量混合的溶液，可以輕鬆識別腹股溝管內的神經和繩狀結構。此外，由此產生的“浸潤性水腫”有助於解剖間接囊或經腹筋膜缺損。在LA管理中獲得信心所需的病例數為12~15。此外，與“歷史悠久的”開放性修復結束時的LA浸潤相比，
這種方法提供了良好的“先發制人鎮痛”和更有利的結果，包括在恢復室減少阿片類藥物和止吐藥的使用。
最後，雖然作者表示，LA的廣泛使用“可以顯著降低該通用程式的成本”，但我們禮貌地建議可以用“does”代替
（認為結論是肯定的？局麻好是事實？）
。鑑於我們日益老齡化的人口，其中許多人正在服用多種藥物，我們都應該能夠在洛杉磯提供並進行修復。我們的病人將非常感激。
原文
Local or general anesthesia when repairing inguinal hernias？
The results of many retrospective reviews， even from prospective databases， are often criticized because of the inherent bias associated with such studies。 However， these thoughts can be safely discarded given the number of patients analyzed from this Veterans Affairs Surgical Quality Improvement Program report1 in which 23% of nearly 100，000 patients underwent herniorrhaphy or hernioplasty using local anesthesia （LA） over a ten-year period。 These patients spent significantly less time in the recovery room after surgery and suffered far fewer later postoperative complications。 Many surgeons， especially trainees， may not appreciate the benefits of a repair under LA。 The concept is not new as opposed to the use of expensive robotics！ LA allows rapid mobilization in the ambulatory setting and is devoid of postoperative urinary problems。2 However， the surgeon does need a ‘lighter’ touch and attention to detail in this sensitive region is paramount。 A repair under LA is clearly unnecessary in the younger fitter patient but as hernia repair should be considered an outpatient procedure the chosen anesthetic must perform well in that setting。 An LA repair is the ideal approach in the relatively unfit patient but also an important option in those older patients whether they are frail or not。 It is an important element to a surgeon’s armamentarium when repairing hernias whether inguinal or femoral especially given the aging populations we are all asked to safely manage。 It is probably not used enough as this article hints at。 Why might that be？ It can be a little difficult to attain adequate and comfortable analgesia in the learning curve of its administration。 To this end we have taught our residents the steps in ‘how it is done’ whilst the younger fitter patients undergo repair under general anesthesia。 The administration of a solution of an equal mixture of 0。5% bupivacaine and 1% lignocaine with 1：200，000 adrenaline allows easy identification of the nerves and cord structures in the inguinal canal。 In addition， the resultant ‘infiltrative edema’ aids in the dissection of an indirect sac or the defect in the tranversalis fascia。 The number of cases required to gain confidence in a LA administration is 12e15。 In addition， this approach gives good ‘pre-emptive analgesia’ and more favorable results when compared to the ‘time honored’ additional LA infiltration at the end of an open repair including the lower use of opioids and anti-emetics in the recovery room。3 Finally， whilst the authors state that the wider use of LA “could significantly reduce the costs for this common procedure” we politely suggest that could be replaced with “does”。 Given our increasingly elderly population， many of whom are taking numerous medications， we should all be able to offer and perform repairs under LA。 Our patients will be most grateful。
