ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%452

FIELD BLOCK FOR INGUINAL HERNIA REPAIR- A CLINICAL STUDY
S&iva'umar ()#, Ma&antes&a) J) S&arma, *run'umar *++a,,a
!) *ssistant #rofessor, De,artment of *naest&esia, SSIMS - ./) Davan$ere, (arnata'a)
2) #rofessor, De,artment of *naest&esia, J) J) M) Medical /olle$e) Davan$ere, (arnata'a)
") #rofessor, De,artment of *naest&esia, SSIMS - ./) Davan$ere, (arnata'a)

CORRESPONDING AUTHOR
Dr) S&iva'umar ()#
025!, 2
nd
Main 2
nd
/ross,
1e&ind Modi /om,ound,
M// 2*3 1loc', Davan$ere, (arnata'a)
E%mail4 drs&ivu'umar',5$mail)com
#&4 6! 6627"78

ABSTRACT: BACKGROUND AND OBJECTIVES: #resent clinical study 9as conducted to
evaluate advanta$es of field bloc' for in$uinal &ernia re,air, 9it& res,ect to duration and
:uality of anal$esia, &aemodynamic stability, and s,eed of recovery by usin$ !; lidocaine 9it&
adrenaline) METHODS: Study 9as conducted on 5 ,atients ,osted for elective in$uinal &ernia
re,air) Field bloc' 9as instituted 9it& !; lidocaine 9it& adrenaline 9it& mean volume of "5)4<
ml to bloc' ilioin$uinal, ilio&y,o$astric, $enital branc& of $enitofemoral nerve 9it&
subcutaneous infiltration) #atients 9ere observed for duration and :uality of anal$esia)
=aemodynamic stability 9it& #., systolic and diastolic 1#) #ost anaest&esia recovery 9as
assessed by usin$ >criteria for fast trac' eli$ibility for ambulatory anaest&esia? after t&e
sur$ery) Duration of anal$esia 9as assessed 9it& sub+ective com,laint of ,ain @duration of onset
of anal$esia till t&e sub+ective com,laint of ,ainA) RESULTS: In t&e ,resent study, t&e :uality of
anal$esia 9as eBcellent in 82; of cases, $ood in !7;, fair in <; and ,oor in 4;) C&e mean
duration of anal$esia 9as 2!)2 min @!7 min to 2< minA) *ll ,atients 9ere
&aemodynamically stable t&rou$&out t&e sur$ery) Dsin$ fast tract eli$ibility criteria for recovery
all t&e ,atient &ad a score of !2 at min and all of t&em &ad score of E !2 at !5 min and " min
and 9ere ready to be s&ifted to9ard from t&e F. by,assin$ t&e ,ost anaest&esia recovery
room) CONCLUSION: C&us field bloc' for in$uinal &ernia re,air is a safe tec&ni:ue, t&at
,rovides eBcellent :uality and ,rolon$ed anal$esia, 9it& ra,id recovery and minimal to nil
com,lications)
KEYWORDS: In$uinal field bloc'G eBcellent anal$esiaG ra,id recovery)

INTRODUCTION: =ernia is t&e 9ord derived from Hree' 9ords >=erons? an offs&oot or bul$e)
It is defined by Sir *stley /oo,er @!<4A as >,rotrusion of any viscus or ,art of t&e viscus
t&rou$& an abnormal o,enin$ in t&e 9alls of its containin$ cavity)
!
C&e ,erformed c&oice of anaest&esia for all adult in$uinal &ernia re,air is local, it is safe,
sim,le, effective, and economical, 9it&out anaest&etic side effects) Furt&er more local
anaest&esia administered before t&e incision ,roduces lon$er ,osto,erative anal$esia because
local infiltration, t&eoretically in&ibits build of local nocice,tive molecules and t&erefore, t&ere
is better ,ain control in t&e ,osto,erative ,eriod)
2
=ernia re,air can be ,erformed under s,inal, e,idural, $eneral and in$uinal field bloc')
Field bloc' for in$uinal &ernia re,air is t&e most cost%effective anaest&etic tec&ni:ue for out
,atients under$oin$ unilateral in$uinal &erniorr&a,&y 9it& res,ect to s,eed of recovery,
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%45"

,atient comfort and associated incremental costs)
"
C&ese are not ,rovided into a satisfactory
level by t&e commonly em,loyed tec&ni:ues, suc& as $eneral anaest&esia @H*A or
centrineuraBial bloc'ade) =ence to meet t&e above re:uirements t&e ,resent study of field bloc'
for in$uinal &ernia re,air is underta'en)
OBJECTIVES:

Co evaluate t&e advanta$es of t&is field bloc' for in$uinal &ernia re,air)
Co study t&e duration and :uality of anal$esia by usin$ !; lidocaine 9it& adrenaline)
Co study effects of in$uinal field bloc' 9it& res,ect to s,eed of recovery - ,atients
comfort)
Ft&er side effects ,ertainin$ to t&e in$uinal field bloc')

METHODOLOGY:
* clinical study 9as underta'en 5 ,atients a$ed bet9een !<%7 years ,osted for
elective in$uinal &ernia re,air, a$reein$ and co%o,erative for in$uinal field bloc') Study
9as conducted at /&i$ateri Heneral =os,ital and 1a,u+i =os,ital attac&ed to J)J)M)
Medical /olle$e, Davan$ere durin$ t&e ,eriod of Se,tember 25 to au$ust 28)
Selecti! " #$tie!t%:
o I!cl&%i! c'ite'i$: *dults bet9een !<%7 years a$e belon$in$ to American
Society of Anesthesiologists (*S*( HradeI and *S* Hrade II comin$ for elective
in$uinal &ernia re,air 9it&out any associated diseases)
o E)cl&%i! c'ite'i$: #atients belo9 !< and above 7 years) #atients 9it& *S*
Hrade III and *S* Hrade IV)

#re%anaest&etic evaluation 9as done a day ,rior to t&e elective sur$ery) /onsent 9as
obtained) Iocal anaest&etic test dose for Iidocaine 9as carried out on t&e ,revious day of
sur$ery)
Fn t&e day of sur$ery an intravenous @IVA line 9as secured 9it& no) 2 H IV /annula) C&e
monitors J ,ulseoBimeter, E/H, Koninvasive 1lood #ressure @KI1#A 9ere connected)
#remedication In+) MidaLolam 2 m$ IV 9as administered)

PROCEDURE OF FIELD BLOCK FOR INGUINAL HERNIA REPAIR: Dnder strict ase,tic
,recautions 9it& ,atient in su,ine ,osition, a s'in 9&eal is made +ust &alf an inc& medial to t&e
anterosu,erior iliac s,ine@*SI#A) * 2" H s,inal needle 9as fiBed to a syrin$e containin$ !5 ml of
!; lidocaine 9it& adrenaline) C&e needle 9as t&en directed ,er,endicular to t&e s'in t&rou$&
t&e s'in 9&eal) C&e needle 9as ,laced +ust above transversalis fascia t&rou$& 9&ic& ilioin$uinal
nerve and ilio&y,o$astric nerves traverse 9&ere !5 ml of !; lidocaine 9as in+ected in a fan
s&a,ed manner &ere)
* second 9&eal 9as made over t&e ,ubic tubercle @#CA and 5 ml of !; lidocaine 9it&
adrenaline 9as in+ected) * t&ird s'in 9&eal 9as raised )5 cm above t&e mid,oint of t&e in$uinal
li$ament @M#IA and 5 ml of !; lidocaine 9as in+ected to bloc' $enital branc& of $enitofemoral
nerve)
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%454

C&en by usin$ ! ml of !; lidocaine a subcutaneous@S/A infiltration 9as done alon$ t&e line
of incision to bloc' crossover fibres) C&e maBimum dose of lidocaine 9it& adrenaline to be $iven
9as 8 m$ / '$ 9&ic& 9as 'e,t in mind) * minimum of ! minutes 9as allo9ed after t&e bloc', in
t&is study) M&enever t&e ,atient com,lained of ,ain, at t&e nec' of sac 2 ml of !; lidocaine
9it& adrenaline administered) *t t&e time of &ernia re,air a sedative dose of ,ro,ofol 9as
administered to all ,atients) In t&e ,resent study t&e follo9in$ scale 9as ado,ted to $rade
anal$esia and relaBation)

*+ E)celle!t: #atient comfortable, anal$esia, and sur$ical relaBation ade:uate)
,+ G-: *nal$esia and relaBation ade:uate, minimal discomfort ,resent durin$ sur$ery
alleviated by su,,lementary local anaest&etic a$ent at t&e nec' of sac)
.+ F$i': *nal$esia and relaBation ade:uate, in addition to infiltration of t&e sac ,atients needed
a narcotic su,,lementation)
/+ P': #atients com,lainin$ of severe intolerable ,ain durin$ sur$ery 9it&out relaBation and
re:uired H*)

1lood ,ressure, &eart rate, oBy$en saturation, E/H, monitorin$ 9ere done every 5 minutes till
t&e end of sur$ery) Duration of sur$ery and anal$esia, 9ere noted) C&e si$ns, sym,toms of local
anaest&etics toBicity 9ere observed)
C&en after t&e sur$ery ,ost anaest&esia recovery 9as assessed in o,eration room by
>criteria used to determine fast%trac' eli$ibility after ambulatory anaest&esia? @Cable !Aand t&e
,osto,erative ,ain relief and ,ost%anaest&etic com,lications monitored)
C&e mentioned score is assessed for " min, 9it& interval of !5 min after t&e sur$ery)
Fnce t&e ,atient ac&ieves a score of !2 or more, ,atient is ready to be s&ifted directly to9ards
by,assin$ t&e ,ost anaest&esia recovery room)
C&e total duration of anal$esia @t&e duration of onset of anal$esia till t&e sub+ective
com,liant of ,ainA assessed in all t&e ,atients)

STATISTICAL ANALYSIS: Descri,tive data included mean, standard deviation and ,ercenta$e
9&ic& 9ere determined for t&e study $rou,)

RESULTS: In our study ma+ority of t&e ,atients 9ere in a$e $rou, of !<%" years and 5!%7
years, 9it& mean a$e of "6) *ll of t&em 9ere males, maBimum 9ei$&t 9as <5 '$ and minimum
9ei$&t 9as 5!'$, mean 9ei$&t 7)84 '$s)
Fut of 5 ,atients studied !7 &ad direct &ernia and "4 &ad indirect &ernia) Iidocaine
9it& adrenaline used for field bloc', mean volume used "5)4< mlG maBimum dose allo9ed "8ml
and minimum dose allo9ed "5ml)
"7 ,atients &ad an eBcellent ty,e of anal$esia and relaBation) < ,atients com,lained of
discomfort durin$ sur$ical &andlin$ of t&e &ernia re,air) Co alleviate t&is 2ml of !; lidocaine
9it& adrenaline 9as in+ected at t&e nec' of t&e sac) 4 ,atients 9ere not comfortable 9it& t&e
above measures and needed fentanyl de,endin$ u,on t&eir body 9ei$&t) 2 ,atients &ad no
anal$esia at all, so H* 9as instituted)
Mean duration of sur$ery and anal$esia 9as "6)54 and 2!)2minute res,ectively) C9o
,atients, 9&o received H*, &ad no anal$esia)
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%455

Ko intrao,erative com,lications) *nal$esia and relaBation 9as EBcellent in 82;, Hood
!7;, Fair in <;, ,oor in 4;) Success rate 7;, Failure rate 4;)
Cable 2 s&o9s mean score and standard deviation for eac& ,arameter accordin$ to
/riteria used to determine fast%trac' eli$ibility after ambulatory anaest&esia
Mean score and standard deviation of all 5 ,atients is s&o9n in table 2) Mean score of 2
9as obtained for ,&ysical activity, res,iratory stability, &aemodynamic stability, oBy$en
saturation status and ,ost o,erative ,ain assessment)
Mean score of !)67 9as obtained for level of consciousness and ,ost o,erative emetic
sym,toms, as 2 ,atients 9&o received H* 9ere arousable 9it& minimal stimulation and 2
,atients 9&o received H* &ad transient vomitin$ or retc&in$ at min res,ectively)
< ,atients &ad a Fast trac' eli$ibility score of !2 at 23 min , all of t&em &ad a score of E!2
at 2!53 min and 2"3 min) *ll t&e ,atients 9ere ready to be s&ifted to t&e 9ard by,assin$ t&e ,ost
anaest&esia recovery room)

DISCUSSION: In$uinal &ernia re,air is one of t&e most commonly encountered sur$ical
correction in men re,resentin$ !2)5; of total sur$ical re,air in 1ritain) In ,rovidin$
anaest&esia for in$uinal &erniorr&a,&y, t&e tec&ni:ue c&osen must be most cost effective 9it&
res,ect to s,eed of recovery, ,atient comfort, and associated incremental costs)
"

C&e advanta$e of local anest&esia are safety, sim,licity, effectiveness, cost effective, lo9
rate of recurrence and infection)
5
It is a met&od of c&oice in out,atient sur$ery and for
minimiLin$ t&e cost of sur$ery)
*ny ,atients 9it& &ernia, a field bloc' 9ill reduce t&e anaest&etic ris' to a minimum,
allo9 immediate ambulation and food inta'e, reduce ,osto,erative com,lications suc& as
urinary retention, atelectasis and ,&lebitis, and almost eliminate t&e need for ,ost o,erative
narcotic anal$esia)
7
Iar$e series of studies are available in sur$ical and anaest&esia literature re$ardin$ t&e
usa$e of field bloc' for in$uinal &ernia re,air) Most of t&ese 9ere 9it& H* or neuraBial
anest&esia or monitored anaest&esia care under dee, sedation) 1ut t&e searc& of literature does
not reveal any studies 9&ic& &ave utiliLed field bloc' as a sole anaest&etic a$ent 9it& lidocaine
and adrenaline for in$uinal &ernia re,air)
In vie9 of t&e above, t&e ,resent study 9as underta'en to investi$ate field bloc' for
in$uinal &ernia re,air usin$ !; lidocaine 9it& adrenaline) In t&e ,resent study 5 ,atients of
*S* class I and II ,osted for elective in$uinal &ernia re,air 9ere studied usin$ t&e above
tec&ni:ue)
Many aut&ors &ave used lidocaine alone for in$uinal field bloc'
7, 8
, but it is s&ort actin$)
Follo9ed by t&at, some aut&ors added e,ine,&rine to lidocaine for t&e bloc' because
e,ine,&rine reduces ,lasma concentration of lidocaine, minimiLes toBicity and also ,rolon$ed
,ost o,erative ,ain relief)
<

Some aut&ors 9&o used t&e above combination for institution of bloc' found t&at t&ere
9as an im,rovement in :uality and duration of bloc')
6
In sur$ical ,atients it may be ,ostulated
t&at 2/3 afferent fibers activity may be $enerated not only intrao,eratively but also ,ost
o,eratively, ,artly as result of ,ersistent inflammation and &y,erala$esia at 9ound site 9&ic& is
affected by usin$ lidocaine 9it& adrenaline
<
&ence 9e &ave used t&e combination of lidocaine
9it& adrenaline in our study)
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%457

Cable " s&o9s t&e volume of lidocaine 9it& adrenaline used in t&ree studies) C&e
,resent study 9as t&e combination of t&e above studies and utiliLed a mean volume "5)4< ml of
t&e dru$)

DOSAGE AND CONCENTRATION OF LIDOCAINE WITH ADRENALINE: In our study 9e &ave
used !; lidocaine combine 9it& adrenaline) It &as been su$$ested t&at u,,er limit for lidocaine
9it& adrenaline is 8m$/'$)
4

*s a fairly lar$e volume of dru$ 9as re:uired for t&e bloc', t&e concentration 'e,t at !;
for lidocaine 9it& adrenaline in our study)
C&e mean 9ei$&t of our ,atients 7)84 '$ and mean volume used is "5)4<ml, it become
clear t&at t&e total dose of t&e lidocaine em,loyed by us is 9ell 9it&in t&e u,,er recommended
limit)
0UALITY OF ANALGESIA AND RELA1ATION: In t&e ,resent study 9e $raded "7 ,atients &ad
eBcellent anal$esia and relaBation, no su,,lementation is re:uired durin$ sur$ery) Fnly <
,atients &ad $ood anal$esia and mild discomfort durin$ sac mani,ulation 9&ic& re:uired
su,,lementation) Mit& additional infiltration around t&e nec' of t&e sac 9it& 2ml of lidocaine
!; 9it& adrenaline, 4 ,atients &ad anal$esia $raded as fair 9it& mild ,ain durin$ sur$ery)
C&ese ,atients 9ere $iven fentanyl !%2 $/'$ to alleviate t&e ,ain) 2 ,atients @4;A &ad severe
intolerable ,ain durin$ sur$ery, re:uirin$ conversion to H*)
It &as been observed by various aut&ors t&at at t&e time of traction on t&e sac, ,atients
often com,lain of discomfort)
!, !2
C&is findin$ 9as observed in < ,atients in our ,resent clinical
study)
Some aut&ors used narcotic for ,ain relief durin$ sur$ery)
", !"
In t&e ,resent study 4
,atients re:uire narcotics in additional to local anaest&etic su,,lementation)
* study stated t&at use of sedative dose of ,ro,ofol &as advanta$e of less nausea and
vomitin$, because of antiemetic action 9&ic& in turn results in faster recovery and cost
effectiveness)
!4

Some study stated t&at some sedation durin$ t&e o,eration may be re:uired for anBious
,atients 9&ic& lose some of t&e benefits of avoidin$ H*) #atients 9&o are eBcessively nervous
may be unsuitable for sur$ery under local anaest&esia)
!!
In our study 9e used ,ro,ofol at a dose
of 25m$ at t&e time of in$uinal &ernia re,air) * study 9as conducted in 4 &ernia ,atients 9&o
under9ent sur$ery under local anaest&esia in 9&om )5; 9ere converted to H*)
!5, !7
In our
study, 2 ,atients @4;A re:uired H*)
E,ine,&rine en&ances t&e de$ree and eBtends t&e duration of lidocaine3s ,eri,&eral
nerve bloc')
6
*s ,er /ovino et al
!8
, t&e duration of anal$esic effect of lidocaine is !65 minutes
27)" min for brac&ial ,leBus bloc', for local infiltration 85 min @"5%"4 minA, duration can be
,rolon$ed u, to 2; by addition of e,ine,&rine)
In t&e ,resent study mean duration of anal$esia 9as 2!)2 minutes @!7 min J
2<minA) So t&e ,resent study correlates 9it& studies done by /ovino et al)
In a study aut&or used 2fast trac' eli$ibility criteria3 for all t&e ,atients leavin$ t&e
o,eration room, to assess t&e recovery at every " min interval for meetin$ t&e criteria for
disc&ar$e &ome from day sur$ery unit)
"

So in our ,resent study, 9e &ave used 2fast trac' eli$ibility criteria3 for assessin$ ,ost
anaest&esia recovery after sur$ery for " min at every !5 min interval, to meet t&e criteria to
s&ift t&e ,atients to 9ard by,assin$ t&e recovery room)
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%458

Cable 4 s&o9s studies done by various aut&ors for &ernia re,air under field bloc' or
monitored anaest&esia care as ambulatory anaest&esia)
*ll t&e ,atients after sur$ery 9ere able to move all t&e four eBtremities 9it& out any
limitation of movements) C&e ,resent study correlates (ar' *E et al !66)
5
Since Iocal
anaest&esia does not affect res,iration and circulation .es,iratory stability and =aemodynamic
stability 9as maintained) Durin$ assessment 4< ,atients 9ere a9a'e and fully oriented, but
t9o ,atients 9&o received H* 9ere arousable 9it& minimal stimulation)
FBy$en saturation 9as E 6; in all t&e ,atients, 4< ,atients 9ere ,ain free, but t9o
,atients 9&o received H* com,lained of mild discomfort and 4< ,atients &ad no emetic
sym,toms but t9o ,atients 9&o received H* &ad transient vomitin$ and retc&in$ at 23 minutes)
FAST TRACK ELIGIBILITY CRITERIA RECOVERY SCORE: *ll t&e ,atients &ad a score of !2 at
23 minute, all of t&em &ad a score of E !2 at !5 min and " min) *ll t&e ,atients 9ere ready to be
s&ifted to9ard by,assin$ t&e ,ost anaest&esia recovery room, similar to t&e study done by Son$
D et al)
"

SIDE EFFECTS PERTAINING TO THE INGUINAL FIELD BLOCK: In a study involvin$ 4!
,atients 9&o under9ent in$uinal &ernia re,air 9it& local anaest&esia t9o com,lications 9ere
recorded) Fne ,atient develo,ed 9ound infection, and one ,atient develo,ed 9ound
&ematoma)
22

In our study out of 5 ,atients 9&o under9ent in$uinal &ernia re,air, no suc&
com,lications 9ere recorded)

CONCLUSION: Duration of anal$esia 9as $ood by usin$ !; lidocaine 9it& adrenaline) Field
bloc' 9as found to be safe and fulfills t&e re:uirements of sur$ical relaBation 9it& minimal
alteration in ,&ysiolo$ical &omeostasis) Iidocaine 9it& adrenaline 9as effective for carryin$ out
field bloc' for in$uinal &ernia re,air and ,rovides lon$ duration of ,ost%o,erative ,ain relief)
Field bloc' is t&e best met&od as far as recovery ,rofile is concerned) Field bloc' for in$uinal
&ernia re,air avoids ,oly,&armacy, is safe, economical, 9it& ra,id recovery 9&en com,ared to
neuraBial bloc'ade and H*) Field bloc' for in$uinal &ernia re,air results in minimal or no
com,lications) C&is tec&ni:ue can be used safely in ,atients 9it& res,iratory or cardiovascular
diseases)

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ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%45<

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&ernia re,air) *naest&esiolo$y !66<G5"4"!%"5)
!8) /ovino, 1en+amin H, =elen$, Vasalio) /linical as,ect of Iocal anaest&esia) /&a,ter 4,
Iocal anaest&etic mec&anism of action and clinical use) #ublis&ed by Hrane and
Stralioninc Ke9 Nor' !68745<%56
!<) Din$ N, M&ite #F) #ost%=erniorr&a,&y ,ain in out,atients after ,re%incision ilioin$uinal
&y,o$astric nerve bloc' durin$ monitored anaest&esia care) /an J *naest&
!665G42@!A4!2%!5)
!6) Hianetta E, /uneo S, Vitale 1, /amerini H, Marini #, Stella M) *nterior tension%free re,air
of recurrent in$uinal &ernia under local anaest&esia) *nn Sur$ !666G2"!@!A4!"2%!"7)
2) *,fubaum JI, Mala9ander /*, Hrasela C=, Mise #1S, McIes'ey /, .oiLen MF et al)
Eliminatin$ intensive ,osto,erative care in same%day sur$ery ,atients usin$ s&ort%
actin$ anaest&etics) *naest&esiolo$y 22G68477%84)
2!) Ma =, Can$ J, M&ite #F, OaentL *, Mender .=, Slonins'y * et al) #erio,erative rofecoBib
im,roves early recovery after out,atient &erniorr&a,&y) *naest& *nal$ 24G6<468%
685)
22) #rado E, =errera MF, Ietay FV) In$uinal &erniorr&a,&y under local anest&esia 4 a study
of intro,erative tolerance) *m Sur$ !664G7@<A47!8%7!6)









ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%456

TABLE *: CRITERIA USED TO DETERMINE FAST-TRACK ELIGIBILITY AFTER
AMBULATORY ANAESTHESIA
/

C'ite'i$ Sc'e
#&ysical activity
*ble to move all eBtremities on command 2
Some 9ea'ness in movement of t&e eBtremities !
Dnable to voluntarily move t&e eBtremities
.es,iratory stability
*ble to breat&e dee,ly 2
Cac&y,noea 9it& $ood cou$& !
Dys,noeic 9it& 9ea' cou$&
=emodynamic
Stability
1lood ,ressure P!5; of t&e baseline M*# value 2
1lood ,ressure bet9een !5; and "; of t&e baseline M*#
value
!
1lood ,ressure E"; belo9 t&e baseline M*# value
Ievel of
/onsciousness
*9a'e and oriented 2
*rousable 9it& minimal stimulation !
.es,onsive only to tactile stimulation
FBy$en Saturation
Status
Maintains value E6; on room air 2
.e:uires su,,lemental oBy$en @nasal ,ron$sA !
Saturation P6; 9it& su,,lemental oBy$en
#osto,erative #ain
*ssessment
Kone or mild discomfort 2
Moderate to severe ,ain controlled 9it& IV anal$esics !
#ersistent severe ,ain
#osto,erative emetic
sym,toms
Kone or mild nausea 9it& no active vomitin$ 2
Cransient vomitin$ or retc&in$ !
#ersistent moderate to severe nausea and vomitin$
Tt$l %c'e */



















ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%47

TABLE ,: RECOVERY SCALE

#arameter minutes !5 minutes " minutes
Mean
Score
Standard
deviation
Mean
score
Standard
deviation
Mean
score
Standard
deviation
PHYSICAL ACTIVITY 2 2 2
RESPIRATORY
STABILITY
2 2 2
HAEMODYNAMIC
STABILITY
2 2 2
LEVEL OF
CONSCIOUSNESS
!)67 )2 !)67 )2 !)6< )!4
O1YGEN
SATURATION
STATUS
2 2 2
POST OPERATIVE
PAIN ASSESSMENT
2 2 2
POST OPERATIVE
EMETIC SYMPTOMS
!)67 )2 2 2
TOTAL SCORE !")62 )"67 !")67 )!6< !")6< )!4!


TABLE .: VOLUME OF LIDOCAINE WITH ADRENALINE USED IN THREE STUDIES

St&-2 Tt$l 3l&4e ASIP MPI PT SC Nec5 " t6e
%$c
Earle *S @!67A
!
"4%4 ml @)5;A 5%
!ml
% ")5ml 5%
2ml
2ml
Dier'in$ et al
@!662A
<

55ml @!5%ml !; Q 4 ml
)5;A
25ml 5ml 5ml 2ml %
Dunn J et al
@!664A
!!

42ml @!;A
@7%8 '$A
% % % % %
#resent study "5%"8 ml !5ml 5ml 5ml !ml 2ml













ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 5/ February 4, 2!" #a$e%47!

TABLE /: VARIOUS STUDIES FOR HERNIA REPAIR UNDER FIELD BLOCK OR MONITORED
ANAESTHESIA

Ye$' St&-2 P'ce-&'e Re%&lt
!664 Din$ N et al
!<
M*/ 9it& field
bloc'
*mbulation time <7 !< minutes
Fit for disc&ar$e !!2 46 minutes
!665 (ar' *E et al
5
Field bloc' *ble to 9al' to t&e room assisted by nurse after !)5
&rs but fully able to 9al' 9it&in " &ours)
#ost%o,erative 9ound ,ain !;, =aematoma !;,
Drinary retention nil)
2 ELio H et al
!6
Iocal anest&esia =os,ital stay ran$es " &rs to !4 days)
2 Son$ D et al
"
I=K1%M*/ Q
,ro,ofol
*ll ,atients 9ere transferred directly from
o,eration room to ,&ase II recovery unit)
22 *,fulbaum JI
et al
2

M*/ 9it& field
bloc'
Mean 6 minutes as a recovery time)
.ecovery ran$e 2 minutes to 2! minutes)
Heneral anaest&esia4 6 minutes to 28 minutes)
24 =an$ma et al
2!
Field bloc' Q
#ro,ofol
C&e details are $iven belo9 4