Quality of Recovery After Local Infiltration Under General Anesthesia Via Laryngeal Mask or Spinal Anesthesia for Inguinal Hernia Repair.
Phase: NA
Conditions: Quality of Life, Pain, Postoperative, Personal Satisfaction, Postoperative Complication
Sponsor: Pontificia Universidade Catolica de Sao Paulo

After approval by the Research Ethics Committee of the Faculty of Medical 
Sciences and Health of PUC-SP and filling in the terms of consent, patients were 
submitted to orthopedic surgery in the lower limbs, not Hospital Santa Lucinda, 
and eligible to participate in the study. 
 
Inclusion criteria: 
Patients submitted to surgeries for correction of fractures in a lower hell, 
physical state according to an American Society of Anesthesiologists10 I and II 
and age between 18 and 60 years. 
 
Exclusion criteria: 
(i) refusal to participate in the study; 
(ii) inability to communicate due to altered consciousness or awareness of 
neurological or psychiatric illness; 
(iii) contraindication to the use of non-neuraxial anesthesia or allergy to any of 
the drugs used without study; 
(iv) history of alcohol or drug addiction; and 
(v) history of surgery in the last 10 days. 
 
Drawing: 
Age, sex, physical status, type of surgery, duration, history of prior surgery in the 
lower limbs, and presence (or not) of bladder catheterization will be recorded. 
Patients are randomly allocated into three groups according to a given 
computer-generated program measure (www.random.org): 
Group D. Dexamethasone 8 mg. 
Group O. Ondansetron 4 mg. 
Group P. Distilled water. 
For each patient, a solution to be administered through a wrap opening and 
sealed and containing the study group for the case. The patients involved and the 
data collection researchers will not be aware of the allocation. The solutions are 
prepared by a professional not participating in the study by diluting the agent in 
physiological solution or distilled water until the volume of 5 ml is complete. 
After a pre-anesthetic evaluation, QoR40 questionnaire and entry into the 
operating room, all patients are monitored with cardioscopy, noninvasive blood 
pressure and pulse oximetry. After a venco-lysis, midazolam will be 
administered intravenously before the anesthesia in titrated doses until a grade 
3 or 4 sedation is obtained according to the Ramsay scale11. With the patient in 
position sent, the puncture subarachnoid will be performed without interspace 
L2-L3 or L3-L4 using 26G needle tip Quincke (B. Braun Melsungen S.A). 
Anesthesia will be obtained with a 0.5% hyperbaric bupivacaine injection (20 to 
30 seconds) (Cristália Produtos Químicos e Farmacêuticos Ltda) at a dose of 17.5 
mg if the weight is> 70 kg and / or the production> 150 minutes or 15 mg if 
weight <70 kg, associated with morphine (0.1 mg) without preservative 
(Cristália Produtos Químicos e Farmacêuticos Ltda.). The hydration will be 
maintained with lactated Ringer's solution. In case of failure of the block, the 
anesthetic procedure will be repeated or the technique will be modified for 
general anesthesia and the case will also be excluded. Perioperative sedation is 
achieved by use in metered doses (up to a maximum of 10 mg) or propofol with 

the infusion rate required to achieve a level equal to or greater than 4 on a scale 
proposed by Ramsay. 
 
Post-Anesthesia Recovery Room (PACU): 
Patients are referred to a PACU and will remain until a criterion is reached for a 
discharge (score on a modified Aldrete and Kroulik scale equal to 10). 12 During 
the stay in the series, in the data referring to the presence of pain, nausea , 
vomiting, pruritus, urinary retention, temperature below 36o, length of stay and 
other complications. Patient without complaint of pain is evaluated every 15 
minutes on the numerical scale of 0 to 10, in which "zero" means absence of pain 
and "ten" a stronger pain than you can imagine. Morphine 1 to 2 mg 
intravenously will be administered every 10 minutes for a score below 4 (1 mg 
for pain <7 and 2 mg for pain ≥ 7) when it is present. Respecting the interval of 
10 minutes due to the summative effect of doses followed by morphine. 
However, since the patient presents with neuraxial block (spinal anesthesia), 
algae complaints are not expected. In view of midazolam sedation and / or 
proportional patient and cognitive ability to response. Nausea (and / or 
vomiting) treated with dimenhydrate (100mg). The pruritus will be graded 
according to numerical scale: zero - absence of symptoms, 1 to 3 - mild 
symptoms, 3 to 7 moderate modifiers and 7 to 10 - severe terms. Score above 4 
will indicate the need for treatment with nalbuphine (5 mg) intravenously