Local anesthetic hernia repair in overweight and obese patients

Inguinal hernia repair under local anesthesia (LA) has many advantages and is associated with high patient satisfaction. However, there are concerns of exceeding the maximum safe dose of LA agents in overweight and obese patients. The aim of the present study was to establish whether inguinal hernia repair could be safely performed under LA in overweight and obese patients.

Patients who underwent elective LA hernia repair under a single consultant surgeon were studied retrospectively. Each patient received the same LA mixture developed at our hospital specifically for hernia repair. The mixture includes lignocaine and bupivocaine, both with adrenaline, made up to a volume of 100 ml with saline. Data were collected by case note review, and by postal and telephone surveys.

A total of 125 patients who underwent LA hernia repair, in whom body mass index (BMI) was measured, were studied. Based on the World Health Organization (WHO) classification, there were 35 (28%) normal weight patients and 63 (72%) overweight (BMI>or=25<30) or obese (BMI>or=30) patients. The median BMI was 27 (range 19-38). The mean volumes of LA mixture used for each group were 58 ml and 62 ml, respectively. High day case rates of 91% and 84% were obtained for the two groups, respectively. Complications included three wound hematomas and three simple wound infections, with no significant differences between groups. One patient developed a recurrent hernia (<1%).

Local anesthetic inguinal hernia repair in the obese is safe and well tolerated. Use of a large volume local anesthetic mixture is recommended in overweight and obese patients.