PARAVERTEBRAL SOMATIC NERVE BLOCK FOR OUTPATIENT INGUINAL HERNIORRHAPHY - AN EXPANDED CASE-REPORT OF 22 PATIENTS

Background and Objectives. Inguinal herniorrhaphy is a common outpatie nt surgical procedure. However, anesthetic techniques for inguinal her niorrhaphy are still associated with numerous side effects. Paraverteb ral somatic nerve block (PSNB) has the potential advantage to offer un ilateral abdominal wall anesthesia and longlasting pain relief with mi nimal side effects. We report our initial trial of PSNB for outpatient inguinal herniorrhaphy. Methods. Twenty-two patients received a PSNB at T10 to L2 using 5 mL of 0.5% bupivacaine with epinephrine 1:400,000 at each of the five levels. The onset of surgical anesthesia, duratio n of analgesia, side effects, and patient satisfaction with the techni que were documented. Results. Surgical anesthesia occurred 15-30 minut es after injection. Two patients had a failed block. The mean I SD tim e to onset of discomfort was 14 +/- 11 hours. Time until first narcoti c requirement was 22 +/- 18 hours. Thirteen patients (n = 20) had no i ncisional discomfort 10 hours or longer after their blocks. Three pati ents had epidural spread. Most patients were very satisfied with their anesthetic technique. Conclusions. The results of our initial experie nce suggest that PSNB is a potentially safe and effective technique. I n general, the block provided long-lasting pain relief in most patient s with few side effects. A randomized study comparing paravertebral bl ocks with conventional anesthesia choices is suggested given the findi ngs in this initial series of patients.