Local Anesthesia for the Advanced Open Preperitoneal Hernia Repair

Most advanced preperitoneal inguinal hernia repairs can be done under local anesthesia with sedation, also called Monitored Anesthesia Care (MAC). This involves sedation with IV medication plus injections of numbing medication into the inguinal hernia surgical site.

The IV medications administered as a part of MAC will make you very relaxed and sleepy. They will cause amnesia so that you likely won’t remember anything from the operating room. You will breathe on your own, and therefore do not require a breathing tube in your throat. There is also a decreased risk for nausea and vomiting when waking up from surgery. MAC allows for quicker post-operative recovery, which means you can leave the hospital and go home sooner than you would under general anesthesia.

The local anesthesia is provided by a numbing medication that is injected in a couple different ways. First of all, you will have a nerve block, which is a way of administering regional anesthesia to the area of the inguinal hernia. Additional numbing medication will be injected directly into the tissues near the incision. This combination allows for effective pain control both during and after the procedure. Typically, we use a combination of short acting lidocaine with a long acting bupivacaine.

MAC anesthesia is a great option for anyone with a normal Body Mass Index (BMI) who is undergoing an inguinal hernia repair and has not had prior surgery in that area. Patients with a BMI over 28 and those who have history of prior inguinal hernia repair or who have had their prostates removed may need to have the procedure done under general anesthesia. This decision is often made by your surgeon and anesthesiologist.