Skip to main content
Erschienen in: Hernia 5/2009

01.10.2009 | Original Article

Factors determining the doses of local anesthetic agents in unilateral inguinal hernia repair

verfasst von: H. Kulacoglu, I. Ozyaylali, D. Yazicioglu

Erschienen in: Hernia | Ausgabe 5/2009

Einloggen, um Zugang zu erhalten

Abstract

Background

Today, local anesthesia is used in specialized hernia clinics in most cases. The technique for establishing local anesthesia for inguinal surgery may differ among surgeons. Few articles to date have mentioned the exact doses of local agents. This prospective study aimed to research the doses of local anesthetic agents needed in practice and determine the patient-related and other factors which affected those doses.

Methods

Three hundred consecutive patients who underwent an elective unilateral inguinal hernia repair were planned to be included in the study. Lidocaine as a short-acting, medium-lasting agent and bupivacaine 0.5% as a long-acting agent were chosen. Gender, age, body mass index (BMI), side of hernia (right/left), concomitant disease, history of hernia (primary/recurrent), type of hernia (indirect/direct), Gilbert class of hernia (1–6), size of hernia (small or medium/large or massive), hernia sac content (omentum/intestine), time shift (8 am to 4 pm/later than 4 pm), duration of operation, and institutional experience (first 150 cases vs. latter 150 cases) were recorded.

Results

There were 277 male and 23 female patients. The mean age was 49.73 years (range 16–83; median 50.00). The mean volume of total anesthetic agents (lidocaine + bupivacaine) was 19.79 ml (range 5.5–40; median 19.5). The mean volumes separately were 101.79 mg for lidocaine (range 30–200; median 100) and 48.12 mg for bupivacaine (range 12.5–110; median 50). The patients were discharged after a median time of 2 h postoperatively. Univariate analysis for the total dose of the two agents showed that younger age (≤60 vs. ≥61 years), larger size of hernia, longer duration of operation (≥61 vs. ≤60 min), recurrent hernia, hernia sac content (omentum > intestine), and higher BMI (≥25.1 vs. ≤25.0) were significant parameters. On the other hand, BMI, recurrent hernia, size of hernia, and omentum in the hernia sac were factors that significantly affected the mean lidocaine dose. Higher BMI and recurrent hernia also caused a higher need for bupivacaine. In addition, significantly lower doses of bupivacaine was used in older patients. The significant independent parameters in the multivariate analysis were duration of operation, sac content, and BMI for lidocaine dose, whereas the duration of operation and sac content were determinative for the sum volume of the two agents. None of the recorded parameters were found to be significant for bupivacaine dose in the logistic regression.

Conclusions

This prospective study showed, again, the feasibility of local anesthesia in elective inguinal hernia repair in all patient groups with different characteristics. The mean and maximum doses of local anesthetic agents were well within safety limits, even in recurrent and large hernias. Younger age, large hernias, recurrent hernias, omental mass in the hernia sac, high BMI, and duration of operation might be the factors affecting local anesthetic doses. The significant independent parameters in the multivariate analysis were duration of operation, sac content, and BMI for lidocaine dose, whereas the duration of operation and sac content were determinative for the sum volume of lidocaine and bupivacaine.
Literatur
1.
Zurück zum Zitat Cushing H (1900) I. The employment of local anaesthesia in the radical cure of certain cases of hernia, with a note upon the nervous anatomy of the inguinal region. Ann Surg 31:1–34PubMedCrossRef Cushing H (1900) I. The employment of local anaesthesia in the radical cure of certain cases of hernia, with a note upon the nervous anatomy of the inguinal region. Ann Surg 31:1–34PubMedCrossRef
2.
Zurück zum Zitat Glassow F (1976) Short-stay surgery (Shouldice technique) for repair of inguinal hernia. Ann R Coll Surg Engl 58:133–139PubMed Glassow F (1976) Short-stay surgery (Shouldice technique) for repair of inguinal hernia. Ann R Coll Surg Engl 58:133–139PubMed
3.
Zurück zum Zitat Amid PK, Shulman AG, Lichtenstein IL (1994) Local anesthesia for inguinal hernia repair step-by-step procedure. Ann Surg 220:735–737PubMedCrossRef Amid PK, Shulman AG, Lichtenstein IL (1994) Local anesthesia for inguinal hernia repair step-by-step procedure. Ann Surg 220:735–737PubMedCrossRef
4.
Zurück zum Zitat Kingsnorth A (2009) Local anesthetic hernia repair: gold standard for one and all. World J Surg 33:142–144PubMedCrossRef Kingsnorth A (2009) Local anesthetic hernia repair: gold standard for one and all. World J Surg 33:142–144PubMedCrossRef
5.
Zurück zum Zitat Kurzer M, Belsham PA, Kark AE (2003) The Lichtenstein repair for groin hernias. Surg Clin North Am 83:1099–1117PubMedCrossRef Kurzer M, Belsham PA, Kark AE (2003) The Lichtenstein repair for groin hernias. Surg Clin North Am 83:1099–1117PubMedCrossRef
6.
Zurück zum Zitat Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8:1–7PubMedCrossRef Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8:1–7PubMedCrossRef
7.
Zurück zum Zitat Kehlet H, Bay Nielsen M (2005) Anaesthetic practice for groin hernia repair—a nation-wide study in Denmark 1998–2003. Acta Anaesthesiol Scand 49:143–146PubMedCrossRef Kehlet H, Bay Nielsen M (2005) Anaesthetic practice for groin hernia repair—a nation-wide study in Denmark 1998–2003. Acta Anaesthesiol Scand 49:143–146PubMedCrossRef
8.
Zurück zum Zitat Callesen T (2003) Inguinal hernia repair: anaesthesia, pain and convalescence. Dan Med Bull 50:203–218PubMed Callesen T (2003) Inguinal hernia repair: anaesthesia, pain and convalescence. Dan Med Bull 50:203–218PubMed
9.
Zurück zum Zitat Kingsnorth AN, Britton BJ, Morris PJ (1981) Recurrent inguinal hernia after local anaesthetic repair. Br J Surg 68:273–275PubMedCrossRef Kingsnorth AN, Britton BJ, Morris PJ (1981) Recurrent inguinal hernia after local anaesthetic repair. Br J Surg 68:273–275PubMedCrossRef
10.
Zurück zum Zitat Sanjay P, Woodward A (2007) Inguinal hernia repair: local or general anaesthesia? Ann R Coll Surg Engl 89:497–503PubMedCrossRef Sanjay P, Woodward A (2007) Inguinal hernia repair: local or general anaesthesia? Ann R Coll Surg Engl 89:497–503PubMedCrossRef
11.
Zurück zum Zitat Rosenberg PH, Veering BT, Urmey WF (2004) Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med 29:564–575; discussion 524PubMed Rosenberg PH, Veering BT, Urmey WF (2004) Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med 29:564–575; discussion 524PubMed
12.
Zurück zum Zitat Covino BG, Wildsmith JAW (1998) Clinical pharmacology of local anesthetic agents. In: Cousins MJ, Bridenbaugh PO (eds) Neural blockade in clinical anesthesia and management of pain. Lippincott-Raven, Philadelphia, pp 97–128 Covino BG, Wildsmith JAW (1998) Clinical pharmacology of local anesthetic agents. In: Cousins MJ, Bridenbaugh PO (eds) Neural blockade in clinical anesthesia and management of pain. Lippincott-Raven, Philadelphia, pp 97–128
13.
Zurück zum Zitat Kenkel JM, Lipschitz AH, Shepherd G, Armstrong VW, Streit F, Oellerich M, Luby M, Rohrich RJ, Brown SA (2004) Pharmacokinetics and safety of lidocaine and monoethylglycinexylidide in liposuction: a microdialysis study. Plast Reconstr Surg 114:516–524; discussion 525-6PubMedCrossRef Kenkel JM, Lipschitz AH, Shepherd G, Armstrong VW, Streit F, Oellerich M, Luby M, Rohrich RJ, Brown SA (2004) Pharmacokinetics and safety of lidocaine and monoethylglycinexylidide in liposuction: a microdialysis study. Plast Reconstr Surg 114:516–524; discussion 525-6PubMedCrossRef
14.
Zurück zum Zitat Covino BG (1993) Local anesthetics. In: Ferrante FM, VadeBoncouer TR (eds) Postoperative pain management. Churchill Livingstone, New York, pp 211–253 Covino BG (1993) Local anesthetics. In: Ferrante FM, VadeBoncouer TR (eds) Postoperative pain management. Churchill Livingstone, New York, pp 211–253
15.
Zurück zum Zitat O’Connor T, Abram S (2003) Atlas of pain injection techniques. Churchill Linvingstone, London, p 117 O’Connor T, Abram S (2003) Atlas of pain injection techniques. Churchill Linvingstone, London, p 117
16.
Zurück zum Zitat Kastrissios H, Triggs EJ, Sinclair F, Moran P, Smithers M (1993) Plasma concentrations of bupivacaine after wound infiltration of an 0.5% solution after inguinal herniorrhaphy: a preliminary study. Eur J Clin Pharmacol 44:555–557PubMedCrossRef Kastrissios H, Triggs EJ, Sinclair F, Moran P, Smithers M (1993) Plasma concentrations of bupivacaine after wound infiltration of an 0.5% solution after inguinal herniorrhaphy: a preliminary study. Eur J Clin Pharmacol 44:555–557PubMedCrossRef
17.
Zurück zum Zitat Karatassas A, Morris RG, Walsh D, Hung P, Slavotinek AH (1993) Evaluation of the safety of inguinal hernia repair in the elderly using lignocaine infiltration anaesthesia. Aust N Z J Surg 63:266–269PubMedCrossRef Karatassas A, Morris RG, Walsh D, Hung P, Slavotinek AH (1993) Evaluation of the safety of inguinal hernia repair in the elderly using lignocaine infiltration anaesthesia. Aust N Z J Surg 63:266–269PubMedCrossRef
18.
Zurück zum Zitat Pippa P, Cuomo P, Panchetti A, Scarchini M, Poggi G, D’Arienzo M (2006) High volume and low concentration of anaesthetic solution in the perivascular interscalene sheath determines quality of block and incidence of complications. Eur J Anaesthesiol 23:855–860PubMedCrossRef Pippa P, Cuomo P, Panchetti A, Scarchini M, Poggi G, D’Arienzo M (2006) High volume and low concentration of anaesthetic solution in the perivascular interscalene sheath determines quality of block and incidence of complications. Eur J Anaesthesiol 23:855–860PubMedCrossRef
19.
Zurück zum Zitat Rucci FS, Barbagli R, Pippa P, Boccaccini A (1997) The optimal dose of local anaesthetic in the orthogonal two-needle technique. Extent of sensory block after the injection of 20, 30 and 40 mL of anaesthetic solution. Eur J Anaesthesiol 14:281–286PubMedCrossRef Rucci FS, Barbagli R, Pippa P, Boccaccini A (1997) The optimal dose of local anaesthetic in the orthogonal two-needle technique. Extent of sensory block after the injection of 20, 30 and 40 mL of anaesthetic solution. Eur J Anaesthesiol 14:281–286PubMedCrossRef
20.
Zurück zum Zitat Nienhuijs SW, Remijn EE, Rosman C (2005) Hernia repair in elderly patients under unmonitored local anaesthesia is feasible. Hernia 9:218–222PubMedCrossRef Nienhuijs SW, Remijn EE, Rosman C (2005) Hernia repair in elderly patients under unmonitored local anaesthesia is feasible. Hernia 9:218–222PubMedCrossRef
21.
Zurück zum Zitat Reid TD, Sanjay P, Woodward A (2009) Local anesthetic hernia repair in overweight and obese patients. World J Surg 33:138–141PubMedCrossRef Reid TD, Sanjay P, Woodward A (2009) Local anesthetic hernia repair in overweight and obese patients. World J Surg 33:138–141PubMedCrossRef
22.
Zurück zum Zitat Andersen FH, Nielsen K, Kehlet H (2005) Combined ilioinguinal blockade and local infiltration anaesthesia for groin hernia repair—a double-blind randomized study. Br J Anaesth 94:520–523PubMedCrossRef Andersen FH, Nielsen K, Kehlet H (2005) Combined ilioinguinal blockade and local infiltration anaesthesia for groin hernia repair—a double-blind randomized study. Br J Anaesth 94:520–523PubMedCrossRef
23.
Zurück zum Zitat Callesen T, Bech K, Kehlet H (2001) Feasibility of local infiltration anaesthesia for recurrent groin hernia repair. Eur J Surg 167:851–854PubMedCrossRef Callesen T, Bech K, Kehlet H (2001) Feasibility of local infiltration anaesthesia for recurrent groin hernia repair. Eur J Surg 167:851–854PubMedCrossRef
Metadaten
Titel
Factors determining the doses of local anesthetic agents in unilateral inguinal hernia repair
verfasst von
H. Kulacoglu
I. Ozyaylali
D. Yazicioglu
Publikationsdatum
01.10.2009
Verlag
Springer-Verlag
Erschienen in
Hernia / Ausgabe 5/2009
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-009-0513-2

Weitere Artikel der Ausgabe 5/2009

Hernia 5/2009 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.