Most hernias can be operated on using direct Local Anaesthetic infiltration with intravenous sedation. Epidural or spinal anaesthesia – into the back is not necessary and can have serious side effects.
Many patients are attracted to or prefer local anaesthesia because of a fear of general anaesthesia or a previous unpleasant experience. There are also specific indications and advantages of local anaesthesia.
Patients are mobilized during the procedure. That is, during the procedure they wiggle their toes around to keep the calf muscles active and the blood circulating. The patient is also asked to cough. This keeps the lungs aerated and helps test the hernia repair and thus reduces one of the major risks of modern surgery – thromboembolism – that is clots in the legs, which may travel to the lungs. Another term used these days is “economy class syndrome”.
A term, which I have used for many years to describe the after effects of anaesthesia, is “gas lag” a comparison to jet lag – also a phenomenon of aircraft travel.
Coughing and straining during the procedure helps in demonstrating the weakness and that the repair is “TENSION FREE” and sound.
The precise infiltration of the Local Anaesthetic ensures that the sedation is used as a supplement to ensure a relaxing experience rather than requiring a General Anaesthetic. The depth of sedation is managed in conjunction with a Specialist Anaesthetist with skill in this technique.
A long acting Local Anaesthetic is used. This ensures that the post-operative period is comfortable, reducing the need for post-operative narcotics and the risk of vomiting. Post-operative vomiting, respiratory and urinary problems are rare.
The patient is able to walk around immediately or soon after the operation. All this adds up to most patients being able to go home soon after the operation.
In addition there are long-term advantages in avoiding a General Anaesthetic. Memory recall and other cognitive factors are less impaired.
A recent study taken European wide, which I believe can be translated to hernia repair, shows that major surgery undertaken with regional anaesthesia has a significantly decreased morbidity i.e. less complications.
Hernia repair is one of the most commonly performed operations and as a surgeon I look for a technique where I can be almost certain that there is not going to be an adverse outcome.
In over 9,000 cases which I have repaired in this manner there have been very few that have required a full general anaesthetic and this includes large hernias.