The use of mesh in hernia repair, risk management and the advantages of day surgery - 
Part 2 - Hernia Repair under Local anaesthesia

The major choices available are:

1.                  GENERAL ANAESTHETIC

Using either:
a.                   relaxant anaesthetic, or
b.                  spontaneous respiration.

While a relaxant anaesthetic requires intubation of the patient, it gives muscular relaxation and good exposure of the area.

Spontaneous respiration is not as readily controlled. The surgical exposure however, is usually satisfactory.

Even with general anaesthesia local anaesthetics can also be infiltrated to:

            reduce the depth of anaesthesia required
provide post operative pain relief.

The local anaesthetic agents or adrenaline should no have any adverse effect or interaction with the general anaesthetic agents or medication being used.

1.                  SPINAL ANAESTHETIC

This is advocated by some in specific circumstances or for repair of bilateral inguinal herniae, but would not be the method of choice in most centres.

2.                  LOCAL ANAESTHESIA INFILTRATION, NERVE BLOCK AND SEDATION

Local anaesthetic is infiltrated into the skin, subcutaneous tissue and around the hernia. Specific nerves may also be blocked. Oral and IV sedation are also used. Diazepam and Lorezapam do not relieve pain, but do have amnesic properties. The depth of sedation is tailored to the circumstances.

The presence of an anaesthetist for a pre-operative check and care during the surgery is reassuring and regarded by most as essential.

This technique is used exclusively in some centres of excellence. However, other surgeons rarely use this technique. This may reflect on the social patterns, the patient’s preference or the belief by the surgeon that general anaesthesia provides better operating conditions for the patient.

There have been dramatic changes in management. Earlier mobilisation has meant reduced time in hospital. The aim is a rapid recovery and an early return to normal activity or the work-force.

General anaesthesia has become increasingly sophisticated and safer. The decreased likelihood of mishaps with increased specialisation suggests that general anaesthesia should be the preferred method.


BACK      NEXT