Study of unilateral postherniorraphy analgesia with local anaesthetic and monitored anaesthesia care

Local anaesthetic with monitored anaesthetic care (MAC) is a very good technique for unilateral-inguinal herniorraphy. We looked at the analgesia produced by the infiltration with local anaesthetic, the intensity of pain in the immediate postsurgery period; the efficiency of oral analgesics and the satisfaction of the patients. Between January and July 1997, 63 patients underwent unilateral-inguinal herniorraphy (Shouldice type) using local anaesthetic (300 mg of mepivacain 1% and 50 mg of bupivacain 0.25%) and MAC (fentanyl, mydazolan and propofol). The intensity of pain was measured using two evaluation scales: visual analogue scale (EV) and verbal scale (Eve). When the patients asked for an analgesic they were given magnesic metamizol (Nolotil), every 6 h. Five patients (8%) felt no pain and 58 felt pain 4 h 36 min after local anaesthetic infiltration (EV=2.5; Eve=1.45) of these 58 patients, 49 took a first dose of ‘Nolotil’ 6 h 40 min after local anaesthetic induction (EV=4; Eve=1.97), 43 received a second dose of ‘Nolotil’ at 13 h 40 min (EV=3; Eve=1.49) and 22 a third dose at 17 h 40 min (EV=3.2; Eve=1.7). Every patient that was very satisfied with the anaesthetic technique, said that the postsurgery pain was bearable and they would be happy to be operated on again with the same anaesthetic-surgery technique. The efficacy of the anaesthetic technique (local anaesthetic with conscious sedation) was very good, 8% of the patients never felt pain and 21% never received any analgesic. The time passed until the first analgesic dose was 6 h 40 min, and the tolerance of the pain was excellent.