[A five-step technique for local anesthesia in inguinal hernia repair].

One century ago, in his 1990 Annals of Surgery article, Cushing indicated that except for children, all hernias can be repaired under local anesthesia [1]. Since then, local anesthesia has been successfully used for the repair of all reducible groin hernias in adult patients at many centers. For the last 25 years, more than 12000 groin hernia repairs have been performed under local anesthesia at the Lichtenstein Hernia Institute. Initially, field block was our method of choice for achieving local anesthesia. During the last 5 years, a simple infiltration technique has been used because the field block was more time consuming and required larger volume of the local anesthetic solution. Furthermore, because of the blind nature of the procedure, it did not always result in satisfactory anesthesia and at times accidental needle puncture of the ilio-inguinal nerve resulted in prolonged postoperative pain, burning, or electric shock sensation within the field of the ilio-inguinal nerve innervation. The purpose of this article is to introduce a simple 5-step infiltration technique that results in satisfactory local anesthesia and prolonged post-operative analgesia requiring a maximum of 30-40 cc of local anesthetic solution.