LOCAL ANESTHESIA FOR GROIN HERNIA REPAIR

Abstract

The kind of anesthesia chosen for a specific surgical operation is closely related to the surgical procedure, health status of the patient and the preference of the surgeon. But especially in developed countries, economical conditions and calculation of cost effectiveness have encouraged performance of local anesthesia for inguinal hernia repair and except obligatory conditions inguinal hernia repair has been performed as an outpatient procedure.

Patients were premedicated with 75-100 mg intramuscular pethidin 1/2 hour before the operation. Intravenous route and monitorization were maintained during the procedure. Prilocain (2 percent) diluted 1/4 with normal saline was used as local anesthetic. After the ilioinguinal and iliohypogastric nerves were blocked 2.5 cm medial to the anterior superior iliac spine, the solution was injected from the same point towards the umblicus, the inguinal ligament and the incisional line. The local anesthetic was injected around the internal ring, to the neck of the hernia sac and into the spermatic cord without injuring the vascular structures, after the external oblique fascia was dissected.

In this study 87 patients were operated with the mean age of 54 (18-84). 71 were indirect, 11 were direct, 2 were pantaloon and 3 were femoral hernias. Repairs used were modified Bassini for 50 patients, Shouldice for 26, McWay for 6 and posterior wall darn for 5 patients. Conversion to general anesthesia was not needed in any of the patients. The average duration of surgery was 55 min (30-80 min). The average postoperative hospitalization was 1.7 days. Postoperative complication rate was 4.5 %. Mean follow-up time was 13.6 months and two recurrences were observed. We suggest local anesthesia as a feasible, safe and cost effective technique for the repair of inguinal hernias.