Background: According to current guidelines, up to 200 mg of lidocaine or 170 mg of bupivacaine can be administered during inguinal hernia repair. In common practice, significantly lower doses of local anesthetics (LA) are used. Research was conducted to estimate the optimal dose of LA which is required to perform primary inguinal hernia repair.
Material and method: The study group included 94 males and 8 females (median age 54 years). The Lichtenstein, Valenti and Trabucco methods were used. Local anesthesia was performed according to the technique reported by Amid. In each operation, between 20 and 100 ml (median 50 ml) of a mixture of equal volumes of 0.25% bupivacaine and 0.5% lidocaine was used (+ 1 ml of 8.4% sodium bicarbonate per 9 ml of anesthetic mixture) Pain severity during the perioperative period and course of convalescence were assessed.
Results: There was no correlation found between the volume of LA used and patient sex, age, premedication or operative technique used. Hernias with a large tissue defect (Type 3) required more anesthetic. A linear correlation was found between patient weight and LA volume. Although overweight and obese patients received more anesthetic, they experienced more severe pain on the 1^st and 2^nd postoperative day in comparison to other patients. Pain severity did not influence convalescence. Recurrence was found in 2% of the patients during the long-term follow-up.
Conclusions: The maximum recommended LA doses do not consider patient condition or method of administration. It appears that in infiltrative anesthesia of the inguinal region in healthy individuals, the standard doses of local anesthetics may be too low to provide comfort during the operation. The maximum dosage of the substances present in the mixture of lidocaine and bupivacaine has not been determined.