Postoperative Recovery Time in Inguinal Herniotomy Under Ilioinguinal/Iliohypogastric Block and Sedation Versus General Anesthesia: A Retrospective Propensity-Score Matched Study.

Background Associated advantages of ilioinguinal/iliohypogastric block and sedation versus general anesthesia (GA) for inguinal hernia repair have not been reported. The use of regional anesthesia (RA) is advantageous during the COVID-19 pandemic as it eliminates the need for airway manipulation.This study aimed to determine the association between postoperative recovery time when ilioinguinal/iliohypogastric block and sedation were utilized for inguinal hernia versus GA. Method This single-center retrospective study used multivariable logistic regression to model the anesthetic modality as a function of age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, major comorbidities to generate a propensity score for each patient for matching. Results After screening 295 patients, 80 patients each in the general and regional anesthesia groups were matched.RA was associated with a 35.6 minutes (95% CI: -46.6 to -25.0) shorter total postoperative recovery time when compared to GA without the increased preoperative time and adverse outcomes. Conclusions Inguinal hernia repair, when performed under ilioinguinal/iliohypogastric block and sedation, was associated with reduced postoperative recovery time. This can be advantageous during the time of the COVID-19 pandemic to reduce the risk of aerosol generation and shorten hospital stay. Future research can focus on establishing a causal relationship.

Alternatives to Opioids for Acute Pain Management in the Emergency Department

* Since the opioid crisis is still present, if not worse, it is important for emergency physicians to avoid the use of opioids whenever possible. * Many alternatives exist. Nitrous oxide provides short-term analgesia and can be used in children as young as 1 year of age. * Sub-dissociative doses of ketamine can be used for acute pain relief. Slow infusion decreases the psychoperceptual effects commonly seen with ketamine. It may be of some use even in chronic pain. * Intravenous lidocaine had been recommended for acute pain, particularly due to renal colic. However, more recent studies suggest it is inferior to ketorolac. * The use of ultrasound-guided regional anesthesia has been increasing and has been shown to be of value in acute trauma, central line placement, renal colic, zoster, and chest tube placement.