Paravertebral Block Anesthesia for Inguinal Hernia Repair

Abstract

Choice of anesthesia for inguinal hernia repair remains a controversial topic. Local anesthesia has been described in the literature as the optimal technique, however general and spinal anesthesia are commonly used in practice despite well-known complications and side effects. The regional technique of paravertebral block has been successfully used at our institution for the operative treatment of breast cancer. Its attributes are prolonged sensory block with minimization of postoperative pain, reduction of nausea and vomiting, shortened hospital stay, patient satisfaction, and rapid return to normal activities. These features are desirable in the practice of ambulatory hernia surgery; hence we initiated the use of thoracic/lumbar paravertebral block for that surgical procedure. Paravertebral block anesthesia was performed on 30 consecutive patients. Block placement took an average of 12.3 minutes, in six cases repeat injection at one or two spinal levels was required due to incomplete blockade. Paravertebral block achieved effective anesthesia in 28 of 30 cases; conversion to general anesthesia was performed for two failed blocks. We are reporting postoperative data on the 28 completed blocks. Supplementation of intravenous sedation or injection of local anesthesia successfully treated transient intraoperative pain in 10 cases. Epidural extension of anesthesia resulting in lower limb numbness and motor weakness delayed the discharge of two patients. There were no other complications of anesthesia and no cases of urinary retention. TIme to onset of pain averaged 15 hours, while duration of sensory block was 13 hours. Patients were prescribed a standing order of naproxen 500 mg B.I.D. for 4 days regardless of pain; supplemental oral narcotic use during the 48 hours following surgery averaged 3.5 tablets, with 6 patients not requiring any narcotic. ninety-six percent of patients scheduled for ambulatory surgery were discharged from the postanesthesia care unit, with an average stay of 2.5 hours. Employed patients returned to work on day 5.5 (range 3-10 days); patients who were not employed returned to regular activities in 5.8 days (range 1-14 days). Eighty-two percent of patients reported being "very satisfied" with the anesthetic technique.

Comparative Study of Hernia Block with Bupivacaine Alone and Bupivacaine Plus Dexamethasone as Adjuvant for Open Hernia Repair at Day Care Unit

“…The amount is pain experienced is related to the somatic pain signal which is derived from abdominal wall. The anterior abdominal walls are supplied by sensory neurons which are derived from anterior rami of spinal nerves T6 to L1 [5,6] . Post operative pain and swelling over the incison are the common complication encountered.…”

Comparison of paravertebral block versus fast-track general anesthesia via laryngeal mask airway in outpatient inguinal herniorrhaphy

“…In our study, despite our best attempts to provide a better analgesia with a pre-emptive non-steroidal anti-inflammatory drug (tenoxicam) and with local infiltration of the wound with a long-acting local anesthetic (levobupivacaine) in group GA, VRS of patients just after the surgery until 12 h post-surgery were significantly lower and postoperative analgesic requirements were lower in group PVB. Our findings of long-lasting postoperative analgesia in group PVB could result from the relative avascularity of the paravertebral space and hence the slow uptake of local anesthetic [10], which is the most significant attribute of the PVB technique. Phase 1 PACU time, time to home readiness, and actual discharge time were found to be shorter in group PVB than in group GA, but anesthesia-related time and onset time were longer.…”

“…Paravertebral block (PVB) has been reported to result in effective anesthesia, rapid recovery, and good postoperative analgesia for IH [8][9][10][11][12][13]. Nevertheless, PVB also has a number of disadvantages, such as additional time required to perform the block, possibility of block failure, and the need for training in its usage.…”

Paravertebral Block vs. Caudal Block Using Dexmedetomidine Plus Local Anesthetics for Inguinal Hernia Repair in Pediatrics: A Randomized Prospective Trial

“…The relative avascularity of the paravertebral space and hence the slow uptake of local anaesthetic explained the prolonged duration of analgesia in PVB than CB [17].…”