Inguinal hernia repair: a comparison between local and general anaesthesia.

BACKGROUND: A comparative analysis of outcomes of inguinal hernia repair performed under local (LA) and general anaesthesia (GA) by a single surgeon using a standardized technique of anterior transversalis repair was performed. Ninety-three cases were examined, 56 of which were cases of LA hernia repair. METHODS: A retrospective analysis of the patient hospital record was performed with particular attention to intra-operative and post-operative analgesia requirements. RESULTS: An overall series complication rate of 6.5% (6/93) is reported. Only one of 56 LA patients (2%) required more than 24 h of narcotic analgesic injections compared to 11% (4/37) in the GA group (P < 0.05). The mean total postoperative parenteral narcotic requirement in the LA group was 86+/-14 mg of pethidine as compared to the GA group who had a mean total requirement of 121+/-17 mg of pethidine (P > 0.08). CONCLUSIONS: The LA infiltration technique is an effective method for inguinal hernia repair. This series demonstrates benefits in terms of length of hospital stay and a lower incidence of postoperative parenteral narcotic analgesic requirement although when post-operative parenteral narcotics were required by the LA group of patients, the difference in mean total pethidine requirement was not statistically significant.

Inguinal hernia repair under local anaesthesia.

Repair of inguinal hernia is widely regarded as a simple procedure, requiring no great surgical skill. Published recurrence rates are high, indicating that there is need for improvement in technique. This paper gives details of a satisfactory method which uses local anaesthesia.

Anaesthesia for phaeochromocytoma resection: role of thoracic epidural blockade.

Two case reports are presented of patients who underwent surgical removal of phaeochromocytoma at Goroka Base Hospital, one with the use of thoracic epidural blockade supplemented with light general anaesthesia. This patient had a much smoother perioperative anaesthetic course than the other, with minimal elevation of blood pressure during the procedure. The paper highlights the value of epidural blockade for excision of phaeochromocytoma, especially in situations where the latest recommended methods and advanced monitoring facilities are unavailable.

Surgery in the tropics.

The practice of surgery in the tropics provides experience in the management of a broad range of conditions without many of the aids now regarded as essential in developed countries. Clinical judgement must play a greater role but the often advanced stage of disease at presentation may lessen the need for investigations and limit the treatment options. Subspecialisation is well advanced in many countries but most of the surgery performed in the world is by people not long out of medical school, much less by general surgeons. Western trained surgeons need to take into account local cultural attitudes to disease and disease management. Busy practical surgeons in tropical areas have made notable contributions to knowledge and practice. Burkitt and Huckstep, both in Kampala, and Brand in Vellore are outstanding examples. Each of these men was heavily dependent on a great many comparatively untrained but skilled paramedical workers.

Glossal cysts in four infants.

Cysts at the base of the tongue causing stridor may be fatal if they are not recognised and treated. Digital palpation along the surface of the tongue to the epiglottis is a useful diagnostic method. An operative technique that might avoid the need for tracheostomy is described.

Childhood phaeochromocytoma--two cases.

The clinical features and management of two cases of phaeochromocytoma in childhood are described, with emphasis on the diagnostic value of ultrasonography.

Brain abscess--then and now.

The varieties of brain abscess seen in Papua New Guinea are very much those seen by Sir William Macewen a century ago. A plea is made for early referral, and the essentials of surgical management are outlined.