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Paravertebral Somatic Nerve Block for Outpatient Inguinal Herniorrhaphy: An Expanded Case Report of 22 Patients
  1. Stephen M. Klein, M.D.,
  2. Roy A. Greengrass, M.D., F.R.C.P.,
  3. Christina Weltz, M.D. and
  4. David S. Warner, M.D.
  1. From the Department of Anesthesiology and Surgery, Duke University Medical Center, Durham, North Carolina.
  1. Reprint requests: Stephen M. Klein, M.D., Box 3094, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710.


Background and Objectives Inguinal herniorrhaphy is a common outpatient surgical procedure. However, anesthetic techniques for inguinal herniorrhaphy are still associated with numerous side effects. Paravertebral somatic nerve block (PSNB) has the potential advantage to offer unilateral abdominal wall anesthesia and longlasting pain relief with minimal side effects. We report our initial trial of PSNB for outpatient inguinal herniorrhaphy.

Methods Twenty-two patients received a PSNB at T10 to L2 using 5 mL of 0.5% bupivacaine with epinephrine 1:400,000 at each of the five levels. The onset of surgical anesthesia, duration of analgesia, side effects, and patient satisfaction with the technique were documented.

Results Surgical anesthesia occurred 15-30 minutes after injection. Two patients had a failed block. The mean ± SD time to onset of discomfort was 14 ± 11 hours. Time until first narcotic requirement was 22 ± 18 hours. Thirteen patients (n = 20) had no incisional discomfort 10 hours or longer after their blocks. Three patients had epidural spread. Most patients were very satisfied with their anesthetic technique.

Conclusions The results of our initial experience suggest that PSNB is a potentially safe and effective technique. In general, the block provided long-lasting pain relief in most patients with few side effects. A randomized study comparing paravertebral blocks with conventional anesthesia choices is suggested given the findings in this initial series of patients.

  • regional anesthesia
  • paravertebral
  • herniorrhaphy
  • ambulatory surgery.

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