Ultrasound Blocks for the Anterior Abdominal Wall

7. Inguinal Hernia Repair
Roberto Fumagalli
7. Inguinal Hernia Repair | 65
Inguinal hernia repair is the most frequent operation in
general surgery accounting for 10-15% of all operations (Figure
7.1). At the first day after herniorrhaphy, moderate or severe
pain occurs in 25% of the patients at rest and in 60% during
activity, and on day 6 the incidence is 11% and 33%, respectively
(Callesen 1998). Neither the type of hernia nor the type of repair
seem to influence postoperative pain scores, although young
patients have more activity-related pain after inguinal
herniorrhaphy (Callesen 1998, Lau 2001). Conversely, anesthetic
technique may affect pain severity after inguinal herniorrhaphy
(Callesen 1998, Song 2000).
Inguinal Field Block/Local Infiltration Anesthesia
Step by step IFB/LIA technique performed by surgeons was
first described at the beginning of the previous century and
includes a stepwise infiltration with local anesthetic of the skin,
of subcutaneous tissue, of muscle and fascial layers, of spermatic
cord and of peritoneal sac (Cushing 1900). The procedure is
performed by the surgeon while operating. IIB and gGFB can be
performed directly in the operative field, although it is very
likely that the local anesthetic solution will reach the nerves in