Extraperitoneal laparoscopic hernia repair with local anesthesia

This review aimed to compare laparoscopic preperitoneal herniorrhaphy (LPPH) using a laryngeal mask airway and local anesthesia with conventional open herniorrhaphy using similar anesthetic conditions.

A retrospective review of 238 hernia operations was conducted from October 1996 through September 1998. Laparoscopic preperitoneal hernia repairs with the patient under laryngeal mask airway anesthesia were performed initially using 10 ml of 0.5% bupivacaine (LPPH+10 group). This was compared with hernia repair using 30 ml of 0.5% bupivacaine (LPPH+30 group). Both LPPH groups were compared with a plug and patch "Gilbert" hernia repair group. Postoperative pain was compared in the recovery room and outpatient suite.

The LPPH+30 group required significantly less postoperative pain medication than the LPPH+10 group. The LPPH+30 group required slightly more pain medication in the recovery room than the open hernia repair group, but in the postanesthesia care unit (PACU) unit, the LPPH+30 group used less pain medication. A similar number of LPPH+30 patients, and open hernia repair patients required no pain medication.

The use of a long-acting local anesthetic, (30 ml of 0.5% bupivacaine via laryngeal mask airway) for laparoscopic preperitoneal hernia repair compared favorably with conventional open hernia repair using similar anesthetic techniques.