Hernia Repair under Local Anesthesia

Abstract

Background and Objective: The author introduces a simple five-step infiltration technique that results in
satisfactory local anesthesia and prolonged postoperative analgesia, requiring a maximum of 30 to 40 mL of local
anesthetic solution.
For the last 10 years, more than 200 groin hernia repairs have been performed under local anesthesia
techniques. Initially, field block was the mean of achieving local anesthesia. During the last five years, a simple
infiltration technique has been used because the field block was more time consuming and required larger volume
of the local anesthetic solution. Furthermore, because of the blind nature of the procedure, it did not always result
in satisfactory anesthesia and, at times, accidental needle puncture of the ilioinguinal nerve resulted in prolonged
postoperative pain, burning, or electric shock sensation within the field of the ilioinguinal nerve innervation.
Materials and Methods: More than 200 patients underwent operations at Debaratana Nakhon Ratchasima
Hospital and at Pakthongchai Hospital from January 2007 to December 2015. All patients were assessed preoperatively
by a surgeon and written informed consent was obtained. Patients were monitored intraoperatively for heart rate,
blood pressure and pulse oximetry.
Conclusion: For the last 10 years more than 200 adult patients with reducible groin hernias satisfactorily
underwent operations under local anesthesia without complications.
The preferred choice of anesthesia for all reducible adult inguinal hernia repair is local anesthesia. It is safe,
simple, effective, and economical, without post anesthesia side effect. Furthermore, local anesthesia administered
before the incision produces longer postoperative analgesia because local infiltration, theoretically, inhibits buildup
of local nociceptive molecules and results in better postoperative pain control.