The use of local anaesthetic for open
inguinal hernia surgery has long been restricted to specialist centres. This study aimed to compare the efficacy of spinal anaesthesia and sub-fascial local anaesthetic (LA) for performing open
hernia repair and at the same time provide better post op
pain relief and
early mobilization. Methods: In this randomized clinical trial, 62 male patients aged 16-72 were randomly allocated to two groups. Group A received mixture of 20 ml 0.5% bupivacain,20ml 2%
lignocaine with
adrenaline, 20m
normal saline (N/S), 3 ml NaHCO3 sub-fascially for Local-anaesthetic (LA) inguinal field. block, while Group B received Spinal Anaesthesia (SA) with 0.5%
Bupivacaine. Comparison was made in terms of Visual Analogue Score (VAS) recorded intra-operatively at 0 and 30 minutes and post operatively at 2, 4 and 12 hours at rest and on movement. Need for rescue
analgesia and total
analgesic consumption in both groups were calculated. Interval to
pain free ambulation as well as procedural and anaesthesia related complications were compared. Results: Mean VAS in the
intraoperative period were significantly high in Group A (p-value 0.011) at the start of operation and at 30 minutes (p-value <0.001). However, it did not correlate with patient satisfaction as 90% of patients in Group A successfully underwent the procedure without need for supplemental
analgesia. VAS scores at rest and on movement/
cough were comparable in the post op period at 2, 4 and 12 hours in both groups. Interval to
pain free ambulation was significantly low in Group A (p-value 0.0012).
CONCLUSION: Sub facial LA inguinal field block provides effective anaesthesia with optimum post op
analgesia, prompt recovery and fewer systemic side effects compared to SA and can safely be used for routine open
inguinal hernia surgery.