title: Local anaesthetic repair of uncomplicated paraumbilical hernia without sedation: peri-operative pain and patient satisfaction.
abstract: OBJECTIVE
  Paraumbilical hernia (PUH) is a common condition that usually requires surgical repair. However, there is a dearth of literature on this surgery performed under local anaesthesia (LA) without the use of sedation. The aims of this study were to assess peri-operative pain and patient satisfaction in patients undergoing PUH repair using LA without sedation.
  
  
  METHODS
  All patients having PUH repair under a single consultant between January 2010 and December 2011 were eligible to participate. If eligible for both, patients chose either general anaesthetic (GA) or LA repair. If only eligible for either LA or GA, they were offered this anaesthetic modality. Visual analogue scales were used to report peri-operative pain (10 point score) and satisfaction (%). Results were compared by grade of surgeon (higher surgical trainee (HST) versus consultant).
  
  
  RESULTS
  A total of 63 patients underwent PUH repair (31 GA; 32 LA). Of them, only 28/32 of LA repair patients agreed to participate. LA and GA patients had equivalent age and sex distribution. LA patients had a lower body mass index (BMI) than GA [27.1 (3.7) versus 30.3 (5.1), p = 0.007]. The median length of LA procedure was 24 (17.5-30) minutes. The median LA solution infiltrated was 25 (20-32) ml. Peri-operative pain scores were low [1.1 (0.3-2.9) %] and patient satisfaction was high [96 (91-99) %]. There were no differences in pain, patient satisfaction, duration of procedure and amount of LA infiltrated with increasing BMI. Comparing HST to consultant, the former took longer [30 (25-36) versus 20 (16-24) minutes, p = 0.0007], infiltrated more LA [34.5 (26-47) versus 20 (19-25.5) ml, p = 0.0039], and patients reported more pain [2.75 (1.0-4.95) versus 0.4 (0.2-1.7) %, p = 0.029], but overall satisfaction was equivalent [95.5 (89-99.25) versus 96.3 (92.25-99) %, p = 0.684].
  
  
  CONCLUSIONS
  Open mesh PUH repair using LA without sedation is associated with low peri-operative pain and very high satisfaction when either a higher surgical trainee or a consultant grade is operating.
authors.affiliation: Department of General Surgery, West Suffolk Hospital, Bury St. Edmunds, Suffolk, IP33 2QZ, UK. philipbennett@doctors.org.uk
authors.forename: P C
authors.initials: PC
authors.lastname: Bennett
authors.forename: B
authors.initials: B
authors.lastname: Kumar
authors.forename: E C
authors.initials: EC
authors.lastname: Coveney
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D015992:Body Mass Index; D002045:Bupivacaine; D002983:Clinical Competence; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D017060:Patient Satisfaction; D059035:Perioperative Period; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine
references.citation: Emerg Med (Fremantle). 2003 Feb;15(1):81-8
references.pmid: 12656792
references.citation: Anesth Analg. 1987 Jun;66(6):572-4
references.pmid: 3034106
references.citation: J Postgrad Med. 2003 Apr-Jun;49(2):132-3
references.pmid: 12867688
references.citation: Am J Surg. 1987 Jun;153(6):560-3
references.pmid: 3592070
references.citation: Br J Surg. 1997 May;84(5):630-3
references.pmid: 9171748
references.citation: Hernia. 2007 Apr;11(2):153-6
references.pmid: 17136309
references.citation: Surg Innov. 2010 Sep;17(3):256-60
references.pmid: 20798095
references.citation: Am J Surg. 2002 Dec;184(6):505-8; discussion 508-9
references.pmid: 12488148
references.citation: Surg Endosc. 2009 Aug;23(8):1740-4
references.pmid: 19015918
references.citation: JRSM Short Rep. 2011 Jan 19;2(1):5
references.pmid: 21286228
references.citation: Hernia. 2002 Dec;6(4):175-7
references.pmid: 12424596
references.citation: Hernia. 2005 Oct;9(3):248-51
references.pmid: 15891810
references.citation: Hernia. 2006 Apr;10(2):175-8
references.pmid: 16424994
references.citation: Ann Surg. 1901 Aug;34(2):276-80
references.pmid: 17861015
references.citation: Hernia. 2010 Oct;14(5):455-62
references.pmid: 20635190
references.citation: Hernia. 2004 May;8(2):104-7
references.pmid: 15024630
references.citation: Res Nurs Health. 1990 Aug;13(4):227-36
references.pmid: 2197679
references.citation: Hernia. 2012 Apr;16(2):163-70
references.pmid: 22042383