Local Anesthetic Hernia Repair: Gold Standard for One and All

Excerpt

Irving Lichtenstein pioneered tension-free hernioplasty and radically changed the patient’s experience by introducing the concepts of early ambulation, short hospital stay, and local anesthesia (LA) [1]. Open hernia surgery routinely incorporates the first three of these concepts, but data from national and regional databases show that general anesthesia (GA) is used in 60% to 70% of cases, central neuraxis blockade (regional anesthesia, RA) in 10% to 20%, and LA in only 5% to 15% [2]. These figures contrast with the experience in specialist hernia centers, where LA is used in more than 95% of cases [3‐6]. Why does this variability exist when LA fulfils all the requirements for an ambulatory technique, exclusion criteria are rare, postoperative recovery is rapid, and costs are low? Reid and colleagues have taken this a step further and demonstrated the feasibility of LA in overweight and obese patients [7]. …