Avaliação da resposta inflamatória sistêmica em pacientes submetidos a herniorrafia inguinal sob anestesia local ou raquianestesia : estudo clínico randomizado

Abstract

Medical practice has developed clinical management with less surgical trauma to patients. Modulation and reduction of inflammatory response is associated with favorable results as the length of stay, infection, and mortality. The inguinal hernia repair performed under local anesthesia has proven to be advantageous to the patient in several studies. OBJECTIVE: To evaluate the systemic inflammatory response in patients undergoing inguinal hernia under local anesthesia (LA) and spinal anesthesia (RA). METHODS: We performed a randomized clinical trial with 70 patients with primary unilateral inguinal hernia were randomly divided into two groups, one operated under LA and another in RA. The variables analyzed were: conversion rate, operative time, volume of saline infused during surgery, nausea during surgery, seizure, laboratory variables assessed before surgery and on the 2nd postoperative (CRP, alpha-1-acid glycoprotein , prealbumin, albumin, PINI - Prognostic Inflammatory and Nutritional Index Scoring - interleukin 6), rate of postoperative complications and patient satisfaction. RESULTS: in the dosage of the 2nd postoperative CRP (AL with 5.7 mg / L with RA vs 13.7 mg / l, p = 0.03), interleukin 6 (AL with 3.0 pg / ml vs RA with 5.8 pg / ml, p = 0.04) and PINI (AL with RA with 0.7 vs. 1.3, p = 0.03) were the laboratory variables that were favorable to AL. The postoperative complication rate was more urinary retention was higher in RA group (zero in the LA group versus 17 in the RA group, p = 0.00). The volume of saline infused during surgery was favorable to AL (1677ml vs. 539ml, p = 0.00). CONCLUSION: In patients undergoing unilateral inguinal hernia, local anesthesia had a lower inflammatory response when compared to spinal anesthesia.