Wait a short time and then infiltrate subcutaneously in the line of the incision. Allow time for the anaesthetic to take effect before starting the operation. Keep some local anaesthetic ready to inject into the sac when it is exposed, and to supplement any parts which are not adequately anaesthetised.

 
Complications

The side effects which may be produced by local anaesthetics and their management are described on page 23. These are much more likely to occur if local anaesthetic is injected whilst the tip of the needle is in a vein. Always, therefore keep the needle tip moving when infiltrating large volumes of local anaesthetic.

If the block proves inadequate for surgery consider converting to a general anaesthetic. Sometimes sedation with small doses of an intravenous opiate will help.

If traction is applied to the hernial sac without adequate anaesthesia the patient may feel faint and become bradycardic. This is best treated by interrupting the surgery, infiltrating more local anaesthetic and giving some intravenous atropine if required.

If bupivacaine is being used the block will take longer to develop compared with lignocaine. Some surgeons prefer to inject bupivacaine before putting on their gown and gloves and draping the patient. This gives extra time for the block to develop.

This article contained links to the following additional information:

Table 1 - Volumes & doses of local anaesthetic which should not be exceeded with different sized patients.
Pharmacology of local anaesthetics, Issue 4 (1994).
Calculation of local anaesthetic doses, Issue 4 (1994).

©World Federation of Societies of Anaesthesiologists WWW implementation by the NDA Web Team, Oxford

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