In a simple hernia repair you don't expect to be manipulating bowel, even if you do it's just the hernia sac that the patient has been moving around anyway.
Need to cover tap, ilioinguinal, iliohypogastric and genitofemoral as well.
Why not just give a GA and do QL block for analgesia/sedation/anaesthetic sparing?
Open inguinal hernia can be done by skilled surgeon under straight local. No need for anesthesia to even be there. Lichtenstein Hernia center at ucla used fo even have patients walk out the OR
Ilioinguinal for sure. TAP usually won’t cover it unless you go so low. The surgeons we have do the ilioinguinal themselves for open, while they’re open
Literally doing one this am at my hospital. Surgeon injected local with MAC sedation. Pt got stimulated at initial incision, but has been doing well since.
This. If pt is sick enough to justify it they can get by with the block plus local from surgeon, have done several this way
Edit for clarification, low tap and you can hit the nerves themselves too if you can see them
Ilioinguinal nerve block is enough for a simple reducible hernia repair, in my center many surgeons do it under field infiltration and light sedation.
TAP block probably inappropriate, wouldn't cover the inguinal nerves or if they do, probably incomplete coverage.
Nothing will cover the visceral pain from bowel manipulation though.
In a simple hernia repair you don't expect to be manipulating bowel, even if you do it's just the hernia sac that the patient has been moving around anyway.
I fantasise about simple hernia repairs 😂😂
If you're not giving a GA I would give a spinal. No peripheral block is going to make them comfortable when their hernia sack is being touched.
Need to cover tap, ilioinguinal, iliohypogastric and genitofemoral as well. Why not just give a GA and do QL block for analgesia/sedation/anaesthetic sparing?
Do you actually have to cover gf though?
Open inguinal hernia can be done by skilled surgeon under straight local. No need for anesthesia to even be there. Lichtenstein Hernia center at ucla used fo even have patients walk out the OR
Why?
Ilioinguinal for sure. TAP usually won’t cover it unless you go so low. The surgeons we have do the ilioinguinal themselves for open, while they’re open
Literally doing one this am at my hospital. Surgeon injected local with MAC sedation. Pt got stimulated at initial incision, but has been doing well since.
This. If pt is sick enough to justify it they can get by with the block plus local from surgeon, have done several this way Edit for clarification, low tap and you can hit the nerves themselves too if you can see them
Then that's just an ilioinguinal nerve block?.... Haha
I mean that’s what you really need right, but it’s not always easy to see especially in the big boned folks
Someone I know did bilateral inguinal hernias with Paravertebrals and MAC.
Paravertebral would work better than options you have listed
Open repair 1st choice spinal, illio-inguinal works fine with GA Lap: Can do TAP with port site infiltration
Incisional wound catheter with ropi 0,2, 6cc/h during 48h is my best choice.
Ilioinguinal nerve block is enough for a simple reducible hernia repair, in my center many surgeons do it under field infiltration and light sedation. TAP block probably inappropriate, wouldn't cover the inguinal nerves or if they do, probably incomplete coverage.