What is the basis for selection of anesthesia technique for an open inguinal hernia repair?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Answer

The choice of anesthesia technique may be influenced by patient preferences and the medical history. The current trend toward increasing utilization of ambulatory surgery tends to favor local anesthesia, which allows quick recovery time and thus is safe for early discharge. For older patients or those with high American Society of Anesthesiologists (ASA) scores (indicating underlying cardiovascular or pulmonary disease), local anesthesia causes much less hemodynamic compromise and is far better tolerated than general anesthesia.

For Lichtenstein hernioplasty, local anesthesia is safe and generally preferable. By permitting immediate postoperative mobilization and discharge of the patient on a day-care basis, it helps minimize the length of the hospital stay, the incidence of complications, and the cost of treatment. In addition, a patient under local anesthesia can be asked to cough during the procedure to help the surgeon identify any additional hernias that may be present and to confirm the adequacy of the prosthetic repair.

Large randomized control trials have found overall anesthesia time, urinary retention, and postoperative pain to be less after local anesthesia than after regional or general anesthesia. [46, 47] Although a follow-up study of recurrence by Nordin et al reported an increase in reoperation for recurrence in the local anesthesia group, the investigators suggested that this increase may be negated with increasing use of the Lichtenstein mesh technique and concluded that further follow-up is warranted. [48]

When hernia repair is performed under local anesthesia, patients still feel the discomforts of pressure and traction; such discomforts can be minimized by administering anxiolytic agents. Additionally, the patient must always give consent for the possibility of conversion to general anesthesia should he or she experience difficulty in tolerating the procedure because of anxiety or discomfort.


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