Transient Femoral Nerve Dysfunction During Open Lichtenstein Repair Under Local Anesthesia: A Retrospective Cohort Study
Keywords:
Transient femoral nerve dysfunction (TFND), Lichtenstein hernia repair, Local anesthesia, Inguinal hernia, One-day surgery (ODS)Abstract
Objective
Transient femoral nerve dysfunction (TFND) following inguinal hernia repair under local anesthesia is likely underrecognized because symptoms are typically self-limited. This study evaluated the incidence, clinical presentation, and factors associated with TFND after open inguinal hernia repair under local anesthesia.
Methods
A retrospective cohort study was conducted in 636 consecutive patients undergoing open Lichtenstein inguinal hernia repair under local anesthesia between March 2018 and March 2026. TFND was defined as transient postoperative sensory disturbance over the femoral dermatome and/or motor weakness impairing knee extension or weight-bearing ambulation. Patients were assessed postoperatively until symptom resolution and discharge. Univariable and multivariable logistic regression analyses were performed to identify factors associated with TFND.
Results
TFND occurred in 74 patients (11.6%), including 26 (4.1%) with isolated sensory dysfunction and 48 (7.6%) with motor weakness. All neurological deficits resolved spontaneously within 1.5 – 6 hours without permanent sequelae or unplanned admission. Multivariable analysis identified complex hernia (adjusted odds ratio [aOR] 5.93, p < 0.001), advanced operative phase (phase 2: aOR 6.78, p = 0.001; phase 3: aOR 13.65, p < 0.001), female sex (male sex: aOR 0.30, 95% CI 0.13–0.66; p = 0.017), and left-sided hernia (right-sided hernia: aOR 0.45, 95% CI 0.29–0.83; p = 0.004) as independent factors associated with TFND. Outpatient day surgery was independently associated with lower TFND risk (aOR 0.41, p = 0.006). The composite case-mix index increased progressively across phases (p < 0.001).
Conclusions
TFND after open inguinal hernia repair under local anesthesia occurred in 11.6% of patients but was uniformly transient and self-limited, resolving spontaneously within 1.5 to 6 hours without permanent neurological sequelae or unplanned hospital admission. Multivariable analysis identified complex hernia (aOR 5.93), advanced operative phase (phase 2: aOR 6.78; phase 3: aOR 13.65), female sex, and left-sided hernia as independent risk factors for TFND, while outpatient day surgery was independently protective (aOR 0.41). These findings indicate that TFND is predominantly associated with operative complexity and evolving anesthetic infiltration behavior across the surgeon experience trajectory, rather than a simple dose-dependent effect of local anesthetics. The composite case-mix index further demonstrated that overall operative burden increased progressively across experience phases driven by concurrent changes in hernia complexity and bupivacaine utilization supporting the multidimensional nature of TFND risk in this setting. Greater awareness of this phenomenon and refinement of local-anesthesia infiltration techniques, including potential adoption of ultrasound guidance in complex cases, may improve perioperative safety and reduce TFND occurrence during groin hernia repair.
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