Anaesthetics

Local anaesthetic (LA) means just that - making the area that is ‘local’ to where you are going to operate numb or anaesthetised. So you feel no pain – though you may be conscious of touch or some pressure. Similar to when you go to the dentist.

It does not involve a ‘needle in the back’. That is an epidural or spinal anaesthetic . Not particularly good for hernia repairs for a number of reasons which I’ll talk about later.

What are the advantages of local anaesthetic?

I’ll just list them for now – and provide some links for background reading.
advantages

a) only numbs the part to be operated on
b) no need for drugs throughout the body
c) no difficulty passing urine afterwards (see complications of hernia repair) 
 
Benefits

a) rapid recovery
b) no nausea / vomiting (from the drugs used in GA)
c) no sore throat (from the tube used in GA)
d) less post-operative pain than after GA for at least the first 24 hours

Can local anaesthetic be used for all hernia repairs?

It cannot be used for laparoscopic / keyhole repairs. It cannot be used when the hernia is irreducible - stuck and will not go back. And It should not really be used in young or very nervous patients.

Why doesn’t everyone repair hernias under local anaesthetic?

You have to be quite skilled at hernia repair before you can do one under LA. They may take a little longer to do – you have to be quite gentle and precise with how you handle the tissues. I suspect that many surgeons , under time pressure etc, just can’t be bothered. And its difficult enough to teach young surgeons how to do a hernia operation, without having them try to learn it under LA as well.