This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (36) Citing Articles via Google Scholar Google Scholar Articles by Callesen, T. Articles by Kehlet, H. Search for Related Content PubMed PubMed Citation Articles by Callesen, T. Articles by Kehlet, H. Related Collections Ambulatory Regional Anesthesia

---

AMBULATORY ANESTHESIA

One-Thousand Consecutive Inguinal Hernia Repairs Under Unmonitored Local Anesthesia

Department of Surgical Gastroenterology, H:S Hvidovre University Hospital, Hvidovre, Denmark

Address correspondence and reprint requests to T. Callesen, MD, Department of Anesthesiology, 4132 (HovedOrtoCentret), Rigshospitalet, DK-2100 Copenhagen Ø, Denmark. Address e-mail to callesen{at}rh.dk

To evaluate the feasibility and safety of unmonitored local anesthesia (ULA) for elective open inguinal hernia repair, we made a prospective, consecutive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire 1 mo after surgery and retrieval from 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, 18–95 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; interquartile range, 75–150); 29 patients had complications requiring surgical intervention. Within the first month, three patients died of causes unrelated to hernia surgery, and six had cardiovascular or respiratory events. The questionnaire was returned by 940 patients; 124 were dissatisfied with local anesthesia, day-case setup, or both, primarily because of intraoperative pain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be conducted 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.

IMPLICATIONS: Inguinal hernia repair can be safely performed under unmonitored local anesthesia with infrequent postoperative morbidity and acceptable satisfaction, but intraoperative pain may be a problem.

This article has been cited by other articles:

				P. F. White, H. Kehlet, J. M. Neal, T. Schricker, D. B. Carr, F. Carli, and the Fast-Track Surgery Study Group The Role of the Anesthesiologist in Fast-Track Surgery: From Multimodal Analgesia to Perioperative Medical Care Anesth. Analg., June 1, 2007; 104(6): 1380 - 1396. [Abstract] [Full Text] [PDF]

				R. K. Baumgarten, R. A. Greengrass, and C. A. Wesen Paravertebral Block: The Holy Grail of Anesthesia for Hernia Surgery? Anesth. Analg., January 1, 2007; 104(1): 207 - 207. [Full Text] [PDF]

				F. H. Andersen, K. Nielsen, and H. Kehlet Combined ilioinguinal blockade and local infiltration anaesthesia for groin hernia repair--a double-blind randomized study Br. J. Anaesth., April 1, 2005; 94(4): 520 - 523. [Abstract] [Full Text] [PDF]

				R. E. Burney, M. A. Prabhu, M. L. V. H. Greenfield, A. Shanks, and M. O'Reilly Comparison of Spinal vs General Anesthesia via Laryngeal Mask Airway in Inguinal Hernia Repair Arch Surg, February 1, 2004; 139(2): 183 - 187. [Abstract] [Full Text] [PDF]

				L. J. Saidman, H. Kehlet, and P. F. White The Objectivity of the Editorialist Must Be Questioned * Response Anesth. Analg., August 1, 2002; 95(2): 497 - 498. [Full Text] [PDF]

				H. Kehlet and P. F. White Optimizing Anesthesia for Inguinal Herniorrhaphy: General, Regional, or Local Anesthesia? Anesth. Analg., December 1, 2001; 93(6): 1367 - 1369. [Full Text] [PDF]