Inguinal hernia repair is one of the most commonly performed surgical procedures. To date, there is no consensus on which anesthesia should be used. The objective of this meta-analysis was to assess the efficacy of spinal anesthesia (SA) vs. general anesthesia (GA) in inguinal hernia repair in adults. Eligible studies were identified before January 2020 from PubMed, Embase, ScienceDirect, Cochrane Library, Scopus database as well as reference lists. Outcomes included surgery time, the time in the operation room, the length of hospital stay, pain scores, patient satisfaction, and postoperative complications. Subgroup analysis based on surgical approaches was conducted. Six randomized controlled trials (RCT) and five cohort studies were included. A total of 2593 patients were analyzed. Compared to GA, SA was associated with a longer surgery time (weighted mean difference [WMD]: − 3.28, 95%confident interval [CI]: − 5.76, − 0.81), particularly in laparoscopic repair. Postoperative pain at 4 h and 12 h were in favor of SA following either open or laparoscopic repairs (standard mean difference [SMD]: 1.58; 95%CI: 0.55, 2.61, SMD: 0.99, 95%CI: 0.37, 1.60, respectively); and considering borderline significance, patients receiving SA might be more satisfied with the anesthesia they used for herniorrhaphy (SMD: -0.32, 95%CI: − 0.70, 0.06). Some major complications of scrotal edema, seroma, wound infection, recurrence, shoulder pain were comparable between the two groups. However, patients receiving SA had an increased risk of postoperative urinary retention and headache when compared with GA (relative ratio [RR]: 0.44, 95% CI: 0.23, 0.86, RR: 0.33, 95% CI: 0.12, 0.92, respectively). There was a tendency that the incidence of postoperative nausea and vomiting was lower in SA than GA (RR: 2.12, 95%CI: 0.95, 4.73), especially in open herniorrhaphy. SA can be another good choice for pain relief no matter in open or laparoscopic hernia repairs, but it can’t be confirmed that SA is better than GA.

中文翻译：

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成人腹股沟疝修补术中脊髓麻醉和全身麻醉的比较：系统评价和荟萃分析。

腹股沟疝修补术是最常进行的外科手术之一。迄今为止，对于应使用哪种麻醉尚无共识。这项荟萃分析的目的是评估脊柱麻醉（SA）与全身麻醉（GA）在成人腹股沟疝修补术中的疗效。2020年1月之前从PubMed，Embase，ScienceDirect，Cochrane图书馆，Scopus数据库以及参考文献列表中鉴定了合格的研究。结果包括手术时间，手术时间，住院时间，疼痛评分，患者满意度和术后并发症。进行了基于手术方法的亚组分析。包括六项随机对照试验（RCT）和五项队列研究。共分析了2593例患者。与GA相比，SA与更长的手术时间有关（加权平均差[WMD]：− 3.28，95％置信区间[CI]：− 5.76，− 0.81），尤其是在腹腔镜手术中。开腹或腹腔镜修复术后4 h和12 h的术后疼痛有利于SA（标准均值[SMD]：1.58; 95％CI：0.55，2.61，SMD：0.99，95％CI：0.37，1.60 ）; 考虑到边缘意义，接受SA的患者可能对他们用于疝气的麻醉更为满意（SMD：-0.32，95％CI：-0.70，0.06）。阴囊水肿，血清肿，伤口感染，复发，肩部疼痛的一些主要并发症在两组之间相当。但是，与GA相比，接受SA的患者术后尿retention留和头痛的风险增加（相对比[RR]：0.44、95％CI：0.23、0.86，RR：0.33，95％CI：分别为0.12、0.92）。SA有一种术后恶心和呕吐的发生率低于GA的趋势（RR：2.12，95％CI：0.95，4.73），特别是在开放性疝气中。无论是开放式还是腹腔镜疝气修补术，SA都是缓解疼痛的另一个不错的选择，但无法确定SA优于GA。