Local Anesthesia for Inguinal Hernia Surgery between Evidence and Experience

Abstract

Introduction: Inguinal hernia surgery is one of the most common procedures worldwide. 80 % of them are estimated to be performed under regional or general anesthesia; while 20 % are performed under local anesthesia, contrary to the recommendation of international societies, which accept that most of the patients are candidates for this method.

Objectives: To describe the local anesthetic technique applied by the surgeon himself, exposing its advantages and disadvantages supported by the relevant evidence available.

Methods: A hybrid narrative review was carried out. The anesthetic method used by our group was described. At the same time, a search was performed in the main databases to identify the research supporting and defending the technical aspects and the taken clinical decisions.

Development: There are no absolute contraindications for the selection of local anesthesia; most of them are relative. The anesthetic to be used is lidocaine, although adjuvants can be taken into account. Pre- or intraoperative sedation is not recommended. The anesthetic method involves the subcutaneous phase with a field block technique and the deep incisional phase with tumescent infiltration.

Conclusions: The use of local anesthesia for inguinal hernia surgery though an anterior approach can be considered as the first choice; it is more economical, while urinary and cardiovascular complications are reduced. To achieve a surgery of equal quality to another method of anesthesia, it is important to master the anesthetic technique