Evaluation of the Safety of Inguinal Hernia Repair in the Elderly Using Lignocaine Infiltration Anaesthesia

Abstract

Repair of inguinal hernia using local anaesthesia is becoming increasingly popular as it avoids many of the systemic side effects associated with general or spinaVepidural anaesthesia and provides excellent early postoperative pain relief. Dosages of local anaesthetic approaching the recommended maximum are frequently required for adequate anaesthesia of the inguinal region. The present study describes the disposition and safety of lignocaine with adrenaline in 14 elderly patients to ascertain its safety with a view to more widespread application of the technique in more complicated hernia repairs. Serial plasma lignocaine concentrations were determined for up to 24 h following doses approaching the recommended maximum for infiltration (7 mg/kg). Peak lignocaine concentrations (normalized to 7 mg/kg) ranged from 0.23 to 0.90mg/L (mean of 0.54 mg/L): that is, the maximum recorded concentration was less than one-fifth the toxicity threshold for lignocaine of 5 mg/L. The study suggested that the majority of patients tolerated the local anaesthetic approach very well and that the wide safety margin allowed ample scope to develop the local anaesthetic approach for the repair of more complex hernia repairs (e.g. large, bilateral or strangulated herniae, or those in obese patients) without risk of exposing patients to lignocaine concentrations which may cause toxic side effects.

Low concentrations of lidocaine for inguinal hernia repair under local infiltration anaesthesia

“…The concentration of lidocaine used for inguinal hernia repair usually varies between 0.5% and 2%, 3,7,9,10 and may be combined with other local anaesthetics or epinephrine. 18,19 High-dose lidocaine is acceptable in situations where only a small volume is required (such as dentistry) but may lead to overdose in more complex procedures such as goitre or hernia repair; 7 a problem compounded by the increased toxicity of lidocaine in the presence of other local anaesthetics (e.g.…”

“…3–5 The local anaesthetic lidocaine has a rapid onset, high dose limitation and moderate duration of action. 6–8 The concentration of lidocaine used for hernia repair ranges between 0.5% and 2%, 3,7,9,10 but lidocaine toxicity increases as its concentration rises 7,11,12 and when used in combination with other anaesthetics or epinephrine. 13,14 In our experience, a lidocaine concentration of <0.5% provides satisfactory anaesthetic effect in hernia repair without the use of other anaesthetics or epinephrine.…”

Lichtenstein hernia repair under different anaesthetic techniques with special emphasis on outcomes in older people

“…Karatassas et al. [14] evaluated the outcomes of a short series of 14 older patients and showed that local anaesthetic lignocaine infiltration anaesthesia is safe and feasible in older people. Nienhuijs et al.…”

Inguinal Nerve Block for Patients Undergoing Inguinal Hernioplasty

“…7 Liehtenstein I (1994) Lane employed a mixture of Lignocaine and Bupivacaine 50%: 50% mixture of 1% lignocaine provided rapid onset of anesthesia while Bupivacaine ensured a longer duration reduction in time of onset was reported with addition of soda bicarbonate 1 meq for every 10ml of lignocaine used. 8 Karatassas (1993) demonstrated a wide safety margin with local anesthetic drug in inguinal herniorraphy. Based on this study they recommended that large volume of local anesthetic agents can be safely used.…”

“…Based on this study they recommended that large volume of local anesthetic agents can be safely used. 9 Young series studied comparison of local, spinal and general anesthesia for inguinal herniorraphy. In their observation 28% of spinal anesthesia cases required conversion to general anesthesia but only 2% in local anesthesia patients required general anaesthesia.…”