Local anesthesia for treatment of hernia in elder patients: Levobupicavaine or Bupivacaine?

Abstract

BackgroundInguinal hernia is one of the most common diseases in the elderly. Treatment of this pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia.MethodsThe aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine to the same obtained by bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from March 2011 to March 2013. We collected data of eighty patients, male and female, aged between 65 and 86 years, who underwent inguinal hernioplasty with local anesthesia.ResultsEvaluation of intra-operatively pain shows that minimal pain is the same in both groups. Mild pain was more frequent in the group who used levobupivacaine. Moderate pain was slightly more frequent in the group who used bupivacaine. Only one reported intense pain. Two drugs seem to have the same effect at a distance of six, twelve, eighteen and twentyfour hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. Degree of satisfaction expressed by patients has been the same in the two groups. Levobupivacaine group has shown a greater request for paracetamol while patients who experienced bupivacaine have showed a higher request of other analgesics.ConclusionsClinical efficacy of levobupivacaine and racemic bupivacaine are actually similar, when used under local intervention of inguinal hernioplasty. In the field of ambulatorial surgery our working group prefers levobupivacaine for its fewer side effects and for its easy handling.

Fibrin glue versus stapler fixation in laparoscopic transabdominal inguinal hernia repair: A single center 5-year experience and analysis of the results in the elderly

“…Indeed, is evident that staple mesh fixation is safe in the hands of an expert laparoscopic hernia repair surgeon [29]. Surgery could be more difficult in elderly patients [30] but we consider laparoscopy as feasible in emergency [31] and it is a secure technique in young patients and in the elderly [32e38] also in wound defects repair.…”

Inguinal hernia repair in patients under and over 65 years of age: a district general hospital experience

“…11 It is considered preferable in patients with multiple comorbidities undergoing open inguinal hernia repair. 16,24 None of the patients in our study had their hernia repaired under local anaesthesia which is another limitation of our study.…”

Postoperative analgesia after inguinal hernia repair - Comparison of ropivacaine with bupivacaine: A randomized controlled trial

“…[ 1 2 ] Surgical site infiltration has an edge over other methods of analgesia in terms of lesser side-effects and is simple to perform. [ 3 ] Infiltration at the surgical site has a limitation that only long-acting local anesthetics provide sufficient duration of analgesia. [ 4 ] Bupivacaine is the classical long-acting local anesthetic that has been used successfully for local infiltration.…”