Hernia surgery involves repairing a weakness in the abdominal wall where an organ or tissue protrudes. Anesthesia is always used during these procedures to ensure patient comfort and safety. While “being put to sleep” is a common perception, various types of anesthesia are available for hernia repair, tailored to different patient needs and surgical approaches. The choice of anesthesia is a discussion between the patient, surgeon, and anesthesiologist, aiming for the most suitable option for the individual.
Understanding Anesthesia Options
For hernia repair, healthcare providers typically choose from general, regional, or local anesthesia, each affecting the body differently. These options are selected based on how they numb the body and the patient’s level of consciousness during the procedure.
General anesthesia induces unconsciousness, where patients have no memory of the procedure. This is achieved by administering medications intravenously or as an inhaled gas, often requiring a breathing tube to support respiration during the surgery.
Regional anesthesia numbs a larger area of the body while the patient remains awake or lightly sedated. Common forms for lower body surgeries like hernia repair include spinal and epidural anesthesia. Spinal anesthesia involves a single injection into the fluid surrounding the spinal cord in the lower back, quickly numbing the lower half of the body. Epidural anesthesia uses a thin catheter inserted into the epidural space in the back, allowing for continuous or adjustable medication delivery to numb the area.
Local anesthesia is the least extensive type, involving an injection directly into the surgical area. This method numbs only the immediate surgical site, and patients remain fully awake, though they may receive additional sedatives to help them relax. Local anesthesia is typically reserved for smaller, less complex hernias and is often used in conjunction with monitored sedation to enhance comfort.
Factors Guiding Anesthesia Choice
The selection of anesthesia for hernia surgery depends on several individual and procedural factors. A patient’s overall health status, including any existing heart or lung conditions, plays a significant role, as certain medical issues might make general anesthesia riskier. In such cases, regional or local anesthesia may be a safer choice. The characteristics of the hernia, such as its type, size, location, and whether it involves incarcerated or strangulated tissue, also influence the decision.
The surgical technique is another determinant; laparoscopic (keyhole) hernia repair almost always requires general anesthesia because it involves inflating the abdomen with gas, which can be uncomfortable for an awake patient. Conversely, open hernia repair, which uses a single larger incision, can often be performed effectively with regional or local anesthesia. The surgeon’s experience and preference for a particular anesthetic approach can also guide the choice. Patient preference and anxiety levels are also considered, as some individuals may prefer to be completely unconscious, while others may wish to avoid general anesthesia’s effects.
The Anesthesia Process
Preparing for anesthesia begins well before the surgery day with a pre-anesthesia evaluation. This evaluation typically includes a review of the patient’s medical history, a physical examination, and various laboratory tests, such as blood work. Patients are usually given specific instructions, such as fasting (nothing to eat or drink) for several hours before the procedure, and may be advised to temporarily stop certain medications like blood thinners.
Upon arrival at the hospital, an intravenous (IV) line is placed, and monitoring equipment, including an electrocardiogram (EKG), blood pressure cuff, and pulse oximeter, is attached to track vital signs. Anesthesia is then administered, either through the IV, via a mask for inhaled gas, or by injection for regional and local options. In laparoscopic procedures, the abdomen is inflated with carbon dioxide gas to create space for the surgeon to operate.
Recovering from Anesthesia
Following hernia surgery, patients are typically moved to a Post-Anesthesia Care Unit (PACU) for immediate monitoring as the anesthesia wears off. In the PACU, nurses specially trained in post-surgical care closely observe vital signs, including heart rate, blood pressure, and oxygen saturation. Pain management is also initiated during this period to ensure comfort.
Patients may experience several temporary side effects as they recover from anesthesia. Grogginess and fatigue are common, particularly after general anesthesia, and can persist for 24 to 48 hours. Nausea and vomiting can also occur, often due to the anesthesia medications or pain relief. Discomfort, swelling, and bruising at the surgical site are expected, and some numbness around the incision is also typical. Patients who received general anesthesia with a breathing tube might have a temporary sore throat, and those who underwent laparoscopic surgery may experience shoulder or chest pain from the gas used during the procedure. These effects generally subside as the body continues to recover.