Skip to main content
Top
Published in: Hernia 2/2006

01-04-2006 | Original Article

Comparison of buffered and unbuffered local anaesthesia for inguinal hernia repair: a prospective study

Authors: E. L. Ball, P. Sanjay, A. Woodward

Published in: Hernia | Issue 2/2006

Login to get access

Abstract

Bicarbonate buffered local anaesthetic solutions are known to reduce the pain of infiltration. However, its efficacy in reducing the pain of infiltration in patients undergoing inguinal hernia repair has never been tested. This study aims to test the efficacy of bicarbonate buffered solution in reducing the pain of infiltration and pain for the total surgical procedure in a series of patients undergoing elective inguinal hernia repair. Forty consecutive male patients with unilateral, reducible inguinal hernias were studied prospectively. All patients underwent surgery under local anaesthesia, the first 20 with unbuffered solution and the next 20 using buffered solution. Pain scores were obtained for the infiltration in the anaesthetic room and for the total surgical procedure. In addition, satisfaction scores were obtained at the end of the procedure. The mean pain score for the initial infiltration of unbuffered anaesthetic was 3.00 (range 0–5), and for the buffered anaesthetic it was 1.45 (range 0–4), P=0.02. The mean pain score for the entire procedure for the unbuffered group was 3.05 (range 0–6), and for the buffered group it was 1.45 (range 0–5), P=0.02. The patient satisfaction rate was higher with the buffered solution compared to unbuffered solution (P<0.05). There were no complications reported with either solution. Buffered local anaesthetic solution significantly reduces the perceived pain of inguinal hernia repair, both during the infiltration and during the procedure itself. It is safe to administer and it results in a high rate of patient satisfaction.
Literature
1.
go back to reference Baskerville PA, Jarret PEM (1983) Day case inguinal hernia. Ann R Coll Surg Engl 65:224–225PubMed Baskerville PA, Jarret PEM (1983) Day case inguinal hernia. Ann R Coll Surg Engl 65:224–225PubMed
2.
go back to reference Song D, Grelich NB, White PF, Tongier WK (2000) Recovery profiles and costs of anaesthesia for outpatient unilateral inguinal herniorrhaphy. Anaesth Analg 91:876–881CrossRef Song D, Grelich NB, White PF, Tongier WK (2000) Recovery profiles and costs of anaesthesia for outpatient unilateral inguinal herniorrhaphy. Anaesth Analg 91:876–881CrossRef
3.
go back to reference Gonullu NN, Cubukcu A (2002) Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomised trial. Hernia 6:29–32CrossRefPubMed Gonullu NN, Cubukcu A (2002) Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomised trial. Hernia 6:29–32CrossRefPubMed
4.
go back to reference Ozgun H, Nil Kurt M, Kurt I, Cevikel MH (2002) Comparison of local, spinal and general anaesthesia for inguinal herniorrhaphy. Eur J Surg 168:455–459CrossRefPubMed Ozgun H, Nil Kurt M, Kurt I, Cevikel MH (2002) Comparison of local, spinal and general anaesthesia for inguinal herniorrhaphy. Eur J Surg 168:455–459CrossRefPubMed
5.
go back to reference Merhav H, Rothstein H (1993) A comparison of pulmonary functions and oxygenation following local, spinal and general anaesthesia in patients undergoing inguinal hernia repair. Int Surg 78:257–261PubMed Merhav H, Rothstein H (1993) A comparison of pulmonary functions and oxygenation following local, spinal and general anaesthesia in patients undergoing inguinal hernia repair. Int Surg 78:257–261PubMed
6.
go back to reference Callesen T, Bech K, Nielsen R, Anderson J, Hesselfeldt P, Roikjaer O, Kehlet H (1998) Pain after groin repair. Br J Surg 85:1412–1414CrossRefPubMed Callesen T, Bech K, Nielsen R, Anderson J, Hesselfeldt P, Roikjaer O, Kehlet H (1998) Pain after groin repair. Br J Surg 85:1412–1414CrossRefPubMed
7.
go back to reference Masters JE (1998) Randomised control trial of pH buffered lignocaine with adrenaline in outpatient operations. Br J Plast Surg 51:385–387PubMed Masters JE (1998) Randomised control trial of pH buffered lignocaine with adrenaline in outpatient operations. Br J Plast Surg 51:385–387PubMed
8.
go back to reference Bloom LH, Scheie HG, Yanoff M (1984) The warming of local anaesthetic agents to decrease discomfort. Opthal Surg 15:603 Bloom LH, Scheie HG, Yanoff M (1984) The warming of local anaesthetic agents to decrease discomfort. Opthal Surg 15:603
9.
go back to reference Finkel LI, Berg DJ (1987) Heating lidocaine appears to prevent painful injection (letter). AJR Am J Roentgenol 148:658 Finkel LI, Berg DJ (1987) Heating lidocaine appears to prevent painful injection (letter). AJR Am J Roentgenol 148:658
10.
go back to reference Rund DA (1986) Essentials of emergency medicine, 2nd edn. Norwalk conn: Appleton-century-crofts, p 274 Rund DA (1986) Essentials of emergency medicine, 2nd edn. Norwalk conn: Appleton-century-crofts, p 274
11.
go back to reference Lipchik EO (1988) A technique to decrease the pain of lidocaine injection (letter). AJR Am J Roentgenol 150:950–951PubMed Lipchik EO (1988) A technique to decrease the pain of lidocaine injection (letter). AJR Am J Roentgenol 150:950–951PubMed
12.
go back to reference McMillan AS, Walshaw D, Meechan JG (2002) The efficacy of Emla and 5% lignocaine gel for anaesthesia of human gingival mucosa. Br J Oral Maxillofac Surg 38(1):58–61CrossRef McMillan AS, Walshaw D, Meechan JG (2002) The efficacy of Emla and 5% lignocaine gel for anaesthesia of human gingival mucosa. Br J Oral Maxillofac Surg 38(1):58–61CrossRef
13.
go back to reference Matsumoto AH, Reifsnyder AC, Hartwell GD, Angle JF, Bayne Selby J Jr, Tegtmeyer CJ (1994) Reducing the discomfort of Lidocaine administration through pH buffering. J Vasc Intervent Radiol 5:171–175CrossRef Matsumoto AH, Reifsnyder AC, Hartwell GD, Angle JF, Bayne Selby J Jr, Tegtmeyer CJ (1994) Reducing the discomfort of Lidocaine administration through pH buffering. J Vasc Intervent Radiol 5:171–175CrossRef
14.
go back to reference Shafi T, Koay P (1998) Randomised prospective masked study comparing patient comfort following the instillation of topical proxymetacaine and amethocaine. Br J Ophthalmol 82:1285–1287PubMed Shafi T, Koay P (1998) Randomised prospective masked study comparing patient comfort following the instillation of topical proxymetacaine and amethocaine. Br J Ophthalmol 82:1285–1287PubMed
15.
go back to reference Fitton AR, Ragbir M, Milling MAP (1996) The use of pH adjusted lignocaine in controlling operative pain in the day surgery unit: a prospective, randomised trial. Br J Past Surg 49:404–408CrossRef Fitton AR, Ragbir M, Milling MAP (1996) The use of pH adjusted lignocaine in controlling operative pain in the day surgery unit: a prospective, randomised trial. Br J Past Surg 49:404–408CrossRef
16.
go back to reference Milner QJ, Guard BC, Allen JG (2000) Alkalinization of amide local anaesthetics by addition of 1% sodium bicarbonate solution. Eur J Anaesth 17(1):38–42 Milner QJ, Guard BC, Allen JG (2000) Alkalinization of amide local anaesthetics by addition of 1% sodium bicarbonate solution. Eur J Anaesth 17(1):38–42
17.
go back to reference Gianetta E, De Cian F, Cuneo S, Friedman D, Vitale B, Marinari G, Baschieri G, Camerini G (1997) Hernia repair in elderly patients. Br J Surg 84:983–985PubMedCrossRef Gianetta E, De Cian F, Cuneo S, Friedman D, Vitale B, Marinari G, Baschieri G, Camerini G (1997) Hernia repair in elderly patients. Br J Surg 84:983–985PubMedCrossRef
18.
go back to reference Kark AE, Kurzer MN, Belsham PA (1998) Three thousand one hundred seventy-five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anaesthesia. J Am Coll Surg 186(4):447–456CrossRefPubMed Kark AE, Kurzer MN, Belsham PA (1998) Three thousand one hundred seventy-five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anaesthesia. J Am Coll Surg 186(4):447–456CrossRefPubMed
19.
go back to reference Subramaniam P, Leslie J, Gourlay C, Clezy JKA (1998) Inguinal hernia repair: a comparison between local and general anaesthesia. Aust N Z J Surg 68:799–800PubMedCrossRef Subramaniam P, Leslie J, Gourlay C, Clezy JKA (1998) Inguinal hernia repair: a comparison between local and general anaesthesia. Aust N Z J Surg 68:799–800PubMedCrossRef
20.
go back to reference Amid PK, Shulman AG, Lichtenstein IL (1994) Local anesthesia for inguinal hernia repair step-by-step procedure. Ann Surg 220:735–737PubMedCrossRef Amid PK, Shulman AG, Lichtenstein IL (1994) Local anesthesia for inguinal hernia repair step-by-step procedure. Ann Surg 220:735–737PubMedCrossRef
21.
go back to reference Mackay W, Morris R, Mushlin P (1987) Sodium bicarbonate attenuates pain on skin infiltration with lidocaine, with or without epinephrine. Anaesth Analg 66:572–574 Mackay W, Morris R, Mushlin P (1987) Sodium bicarbonate attenuates pain on skin infiltration with lidocaine, with or without epinephrine. Anaesth Analg 66:572–574
22.
go back to reference Christoph RA, Buchanan L, Begalla K, Schwartz S (1988) Pain reduction in local anaesthetic administration through Ph buffering. Ann Emerg Med 17:117–120CrossRefPubMed Christoph RA, Buchanan L, Begalla K, Schwartz S (1988) Pain reduction in local anaesthetic administration through Ph buffering. Ann Emerg Med 17:117–120CrossRefPubMed
23.
go back to reference Orlinsky M, Hudson C, Chan L, Deslauriers R (1992) Pain comparison of unbuffered versus buffered lidocaine in local wound infiltration. J Emerg Med 10:411–415CrossRefPubMed Orlinsky M, Hudson C, Chan L, Deslauriers R (1992) Pain comparison of unbuffered versus buffered lidocaine in local wound infiltration. J Emerg Med 10:411–415CrossRefPubMed
24.
go back to reference Metzinger SE, Bailey DJ, Boyce RG, Lyons GD (1992) Local anaesthesia in rhinoplasty: a new twist? Ear Nose Throat J 71:405–406PubMed Metzinger SE, Bailey DJ, Boyce RG, Lyons GD (1992) Local anaesthesia in rhinoplasty: a new twist? Ear Nose Throat J 71:405–406PubMed
25.
go back to reference Eccarius SG, Gordon ME, Parelman JJ (1990) Bicarbonate-buffered lidocaine-epinephrine-hyaluronidase for eyelid anaesthesia. Ophthalmology 97(11):1499–1501PubMed Eccarius SG, Gordon ME, Parelman JJ (1990) Bicarbonate-buffered lidocaine-epinephrine-hyaluronidase for eyelid anaesthesia. Ophthalmology 97(11):1499–1501PubMed
26.
go back to reference Stewart JH, Chinn SE, Cole GW, Klien JA (1990) Neutralized lidocaine with epinephrine for local anaesthesia-11. J Dermatol Surg Oncol 16:842–845PubMed Stewart JH, Chinn SE, Cole GW, Klien JA (1990) Neutralized lidocaine with epinephrine for local anaesthesia-11. J Dermatol Surg Oncol 16:842–845PubMed
27.
go back to reference DiFazio CA, Carron H, Grosslight KR, Moscicki JC, Bolding WR, Johns RA (1986) Comparison of ph-adjusted lodocaine solutions of epidural anaesthesia. Anaesth Analg 65:760–764CrossRef DiFazio CA, Carron H, Grosslight KR, Moscicki JC, Bolding WR, Johns RA (1986) Comparison of ph-adjusted lodocaine solutions of epidural anaesthesia. Anaesth Analg 65:760–764CrossRef
28.
go back to reference DeJong RH (1977) Local anaesthetics. Springfield 111:Charles C Thomas, pp 42–50 DeJong RH (1977) Local anaesthetics. Springfield 111:Charles C Thomas, pp 42–50
29.
go back to reference Kingsnorth AN, Bowley DMG, Porter C (2003) A prospective study 1000 hernias: results of the Plymouth Hernia Service. Ann R Coll Surg Engl 85:18–22CrossRefPubMed Kingsnorth AN, Bowley DMG, Porter C (2003) A prospective study 1000 hernias: results of the Plymouth Hernia Service. Ann R Coll Surg Engl 85:18–22CrossRefPubMed
30.
go back to reference Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, Juul P, Callesen T (2001) Quality assessment of 26,304 herniorrhapies in Denmark: a prospective nationwide study. Lancet 358:1124–1128CrossRefPubMed Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, Juul P, Callesen T (2001) Quality assessment of 26,304 herniorrhapies in Denmark: a prospective nationwide study. Lancet 358:1124–1128CrossRefPubMed
31.
go back to reference Hair A, Paterson C, Wright D, Baxter JN, O, Dwyer PJ (2001) Diagnosis of a femoral hernia in the elective setting. J R Coll Surg Edinburgh 46:117–118 Hair A, Paterson C, Wright D, Baxter JN, O, Dwyer PJ (2001) Diagnosis of a femoral hernia in the elective setting. J R Coll Surg Edinburgh 46:117–118
32.
go back to reference Nilsson F, Anderberg B, Bragmark M, Eriksson T, Fordell R, Happaniemi S, Heuman R, Kald A, Stubberod A, Svensson P (1993) Hernia surgery in a defined population: improvements possible in outcome and cost effectiveness. Ambul Surg 1:150–153CrossRef Nilsson F, Anderberg B, Bragmark M, Eriksson T, Fordell R, Happaniemi S, Heuman R, Kald A, Stubberod A, Svensson P (1993) Hernia surgery in a defined population: improvements possible in outcome and cost effectiveness. Ambul Surg 1:150–153CrossRef
33.
go back to reference O’ Riordan DC, Kingsnorth AN (1998) Audit of patient outcomes after herniorrhaphy. Surg Clin N Am 78:1129–1139CrossRefPubMed O’ Riordan DC, Kingsnorth AN (1998) Audit of patient outcomes after herniorrhaphy. Surg Clin N Am 78:1129–1139CrossRefPubMed
34.
go back to reference Flanagan LJR, Bascom JV (1981) Herniorrhaphies performed upon outpatients under local anaesthesia. Surgery Gynaecol Obstet 153:557–560 Flanagan LJR, Bascom JV (1981) Herniorrhaphies performed upon outpatients under local anaesthesia. Surgery Gynaecol Obstet 153:557–560
35.
go back to reference Callesen T, Bech K, Kehlet H (2001) One-thousand consecutive inguinal hernia repairs under unmonitored local anaesthesia. Anaesth Analg 93:1373–1376CrossRef Callesen T, Bech K, Kehlet H (2001) One-thousand consecutive inguinal hernia repairs under unmonitored local anaesthesia. Anaesth Analg 93:1373–1376CrossRef
Metadata
Title
Comparison of buffered and unbuffered local anaesthesia for inguinal hernia repair: a prospective study
Authors
E. L. Ball
P. Sanjay
A. Woodward
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
Hernia / Issue 2/2006
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-005-0058-y

Other articles of this Issue 2/2006

Hernia 2/2006 Go to the issue

Editorial