LOCAL-ANESTHESIA FOR INGUINAL-HERNIA REPAIR STEP-BY-STEP PROCEDURE

Objective The authors introduce a simple six-step infiltration techniq ue that results in satisfactory local anesthesia and prolonged postope rative analgesia, requiring a maximum of 30 to 40 mt of local anesthet ic solution. Summary Background Data For the last 20 years, more than 12,000 groin hernia repairs have been performed under local anesthesia at the Lichtenstein Hernia Institute, initially, field block was the mean of achieving local anesthesia. During the last 5 years, a simple infiltration technique has been used because the field block was more time consuming and required larger volume of the local anesthetic solu tion. Furthermore, because of the blind nature of the procedure, it di d not always result in satisfactory anesthesia and, at times, accident al needle puncture of the ilioinguinal nerve resulted in prolonged pos toperative pain, burning, or electric shock sensation within the field of the ilioinguinal nerve innervation. Methods More than 12,000 patie nts underwent operations in a private practice setting in general hosp itals. Results For 2 decades, more than 12,000 adult patients with red ucible groin hernias satisfactorily underwent operations under local a nesthesia without complications. Conclusions The preferred choice of a nesthesia for all reducible adult inguinal hernia repair is local. it is safe, simple, effective, and economical, without postanesthesia sid e effects. Furthermore, local anesthesia administered before the incis ion produces longer postoperative analgesia because local infiltration , theoretically, inhibits build-up of local nociceptive molecules and, therefore, there is better pain control in the postoperative period.