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Observational Study
. 2018 Jul;100(6):450-453.
doi: 10.1308/rcsann.2018.0059. Epub 2018 Mar 15.

Benefits of pre-emptive analgesia by local infiltration at day-case general anaesthetic open inguinal hernioplasty

R W Radwan  1 , A Gardner  1 , H Jayamanne  1 , B M Stephenson  1
Affiliations
Observational Study

Benefits of pre-emptive analgesia by local infiltration at day-case general anaesthetic open inguinal hernioplasty

R W Radwan et al. Ann R Coll Surg Engl. 2018 Jul.

Abstract

Introduction The open prosthetic repair of inguinal hernias under local anaesthesia (LA) is well established, with the concept of intraoperative 'pre-emptive analgesia' evolving so that patients are as comfortable as possible. We used a peri-incisional LA solution in patients undergoing day-case inguinal hernioplasty under general anaesthesia (GA) and recorded use of analgesia in the immediate postoperative period. Methods In this observational cohort study, 100 consecutive unselected men underwent open inguinal hernia repair as a day case. Of these, 75 underwent repair under GA and 25 with peri-incisional LA solution (equal mixture of 0.5% bupivacaine and 1% lignocaine with 1:200,000 adrenaline). Analgesia prescribed at induction, for maintenance and after cessation of anaesthesia was scored in accordance with the World Health Organization (WHO) analgesic ladder. Results The median age in the GA group was 59 years (range: 25-89 years) and in the GA+LA group, it was 62 years (range: 27-88 years). Of the 100 patients, 82 underwent a mesh plug repair by seven surgeons whereas 18 underwent a flat (Lichtenstein) mesh repair by two surgeons. WHO analgesic induction and postoperative scores were significantly lower in the GA+LA group (p=0.034 and p<0.001 respectively). There was also a significant difference in use of postoperative antiemetics (23% vs 0% in the GA only and GA+LA cohorts respectively, p=0.020). Six patients (8%) in the GA group failed day-case discharge criteria. Conclusions Patients undergoing contemporary day-case GA inguinal hernioplasty with pre-emptive LA solution infiltration require lower levels of postoperative opioid analgesia and antiemetics. These cases are less likely to fail discharge criteria for planned day surgery.

Keywords: Day surgery; Inguinal hernia; Pre-emptive analgesia.

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Figures

Figure 1
Figure 1
Infiltration of inguinal canal before division of external oblique aponeurosis
Figure 2
Figure 2
The local anaesthetic solution allows for easy identification of the nerves and spermatic cord
Figure 3
Figure 3
Infiltration allows for easy separation of sac from cord structures
See this image and copyright information in PMC

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