Inguinal Hernia Repair Under Local Anesthesia: Benefits, Contraindications, Barriers to Use; A Narrative Review.

BACKGROUND: Inguinal hernia repair is a common surgery worldwide. Despite the advantages of local anesthesia, many healthcare providers avoid using this method due to several barriers relating to patients, surgical team, and operating rooms. METHOD: A review of studies published in PubMed and Google Scholar was conducted to examine outcomes, costs, patient satisfaction, safety, and barriers associated with the use of local anesthesia for inguinal herniorrhaphy. RESULTS: Local anesthesia was associated with many advantages including less postoperative pain, fewer complications, shorter hospital stay, lower healthcare costs, and safer in high-risk patients compared with spinal and general anesthesia. New methods such as tumescent local anesthesia and the combination of hypnosis and conscious sedation with local anesthesia enhance the effectiveness and safety of local anesthesia, improving both surgeon and patient experience. Selected studies demonstrated that using local anesthesia in some traditional contraindications such as obesity and recurrent cases is a safe and effective option. Despite the strong evidence, there are some barriers that limit the use of local anesthesia including patient anxiety, intraoperative pain, surgeon discomfort, staff communication problems, logistic issues, and lack of institutional protocols. CONCLUSION: Local anesthesia is a safe and cost-effective method for inguinal hernia repair. To facilitate the routine use of local anesthesia, it is crucial to address the barriers through training the surgical team, the development of standardized protocols and logistics, and enhanced patient awareness.