Anaesthetic for hernia repair

Hernias can be repaired using a general or a local anaesthetic.

Incisional hernias always require general anaesthetic

 

What is the difference?

With general anaesthetic (GA) you are fast asleep, with local anaesthetic (LA) you are a essentially awake – though a little bit drowsy or sedated, and the area of the hernia is made numb with a local anaesthetic injection (like the one your dentist uses).

 Is local anaesthetic the same as a needle in the back?

No – putting a needle in the back can be either a spinal or an epidural anaesthetic. It is not considered a good technique for hernia repair – (see below)

What does a local anaesthetic – LA – involve?

 It is very similar to the one your dentist uses. The technique I use involves a pinprick near the hip bone on the side of the hernia and then one or two more pinpricks near where the hernia is. The area goes numb within seconds. You would feel some pushing and be aware of touch – but no pain.

Why doesn’t everyone use local anesthetic?

 Not all surgeons are comfortable using LA. You have to be very proficient with the operation itself and you have to be patient and gentle with your technique. It is a little bit more demanding of the surgeon, but if done well it is probably better for the patient.   The specialist hernia centres tend to use local anaesthetic routinely.

What does a general anaesthetic – GA – involve?

Usually just a pinprick in the back of the hand and then you fall asleep within seconds. The anaesthetic drugs nowadays are short-acting , and though you may be drowsy for a short while afterwards this soon wears off. You should be able to go home the same day if you want.

 Is general anaesthetic safe?

Nowadays – yes. Modern general anaesthesia is safe, although side effects such as nausea and vomiting and sore throat sometimes occur. In some patients there may be difficulty passing urine after an inguinal hernia operation, particularly if there were urinary problems before the operation.

 Spinal and epidural anaethetic both make the body below the navel numb for a period time. It is a good method of pain relief for women giving birth but is not so good for having a hernia repair. Some surgeons use spinal anaesthetic either occasionally, and some even routinely (in some Eurpean countries) on all hernias, This type of anaesthetic can give rise to problems, especially in the medically unwell and elderly.  Amongst other things there is a high likelihood being unable to pass urine afterwards. It is also not as safe as some surgeons would maintain and can cause large falls in blood pressure in people with heart conditions.