One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia

To evaluate the feasibility and safety of unmonitored local anesthesia (ULA ) for elective open inguinal hernia repair, we made a prospective, consecut ive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire I mo after surgery and retrieval fro m the electronic patient data management system. In 921 ASA Group I and II and 79 ASA Group III and IV patients, the median age was 60 yr (range, 18-9 5 yr). ULA was converted to general anesthesia in 5 of 1000 cases, and 961 patients were discharged on the day of surgery after 95 min (median; interq uartile range, 75-150); 29 patients had complications requiring surgical in tervention. Within the first month, three patients died of causes unrelated to hernia surgery, and six had cardiovascular or respiratory events. The q uestionnaire was returned by 940 patients; 124 were dissatisfied with local anesthesia, day-case setup, or both, primarily because of intraoperative p ain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be con ducted under ULA, regardless of comorbidity, with a small rate of deviation from day-case setup and minimal morbidity. It provides a safe alternative to other anesthetic techniques with an acceptable rate of satisfaction, but intraoperative pain relief needs improvement.