Inguinal Hernia Repair

Summary

  • Dose: 1.8 ml (9 mg) 0.5% hyperbaric bupivacaine + 20 mcg fentanyl

  • Position: Lateral, set 15 minutes, then supine.

  • Expectation: Surgical anaesthesia for up to 60 minutes.

Evidence

  • 15 mg isobaric bupivacaine (patient lateral, immediately supine) was successful in 97.5% inguinal hernia or varicocoele patients [1]. Surgery lasted ~ 60 minutes and sensory level was ~ T8 (pinprick).

  • 10 mg hyperbaric bupivacaine was successful for inguinal hernia surgery lasting ~ 45 minutes, regardless of whether it was injected lateral (set 20 min), or sitting (then immediately lateral for 20 min) [2]. In both groups a T10 level was established on the operative side and patients voided in ~ 4-4.5 hours.

  • 9 mg (1.8 ml) 0.5% hyperbaric bupivacaine (patient lateral, 40 sec injection, set 15 min) was successful for surgery lasting ~40-45 minutes, regardless of whether bupivacaine was 5°C or 23°C [3].

  • 8 mg of 0.5% hyperbaric bupivacaine (patient lateral, 30 sec injection, set 15 min) was utilised in one study [4]. A level of ~T5 was achieved and voiding occurred after ~5.5 hours. No surgical time or fail data provided.

  • 7.5 mg and 6 mg 0.5% hyperbaric bupivacaine with 25 mcg fentanyl, made up to 3 ml with isotonic saline (patient lateral, 3 min injection, set 15 min) were 95% successful for surgery lasting ~ 70 minutes [5]. Intraoperative fentanyl was required in 30% of 6 mg patients and 5% of 7.5 mg patients.

  • 6 mg 0.5% hyperbaric bupivacaine (patient lateral, set 15 min, then supine) was insufficient for surgery in 33% of cases with duration ~ 80 minutes [6]. Addition of 15 mcg clonidine rendered all blocks sufficient, and increased the sensory level (pinprick) from ~T10 to ~T6. This small amount of clonidine did not change the duration of sensory or motor block.

References

  1. Mantouvalou et al. Spinal anaesthesia: Comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta Anaesthesiologica Belgica 2008;59(2):65-71

  2. Malyan et al. Role of patient posture during puncture on successful unilateral spinal anaesthesia in outpatient lower abdominal surgery. Eur J Anesthesiology 2006;23:491-495.

  3. Tomak et al. Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery. J Anesth 2016;30(1):26-30.

  4. Moizo et al. Unilateral spinal anaesthesia for inguinal hernia repair: a prospective, randomised, double-blinded comparison of bupivacaine, levobupivacaine or ropivacaine. Minerva Anesthesiol 2004;70:542

  5. Gupta et al. Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison b/w 6 mg and 7.5 mg bupivacaine. Acta Anaesthes Scand 2003;47:13-19

  6. Dobrydnjov et al. Clonidine combined with small dose bupivacaine during spinal anaesthesia for inguinal herniorrhaphy: A randomised double-blinded study. Anesth Analg 2003;96:1496-503.