From the Guidelines
For laparoscopic ventral hernia repair, a balanced anesthesia technique is recommended, combining general anesthesia with multimodal analgesia to minimize postoperative pain and optimize recovery 1, 2, 3.
Key Considerations
- Induction: Propofol 1-2 mg/kg and rocuronium 0.6-1.2 mg/kg for muscle relaxation are commonly used 2.
- Maintenance: Sevoflurane or desflurane, titrated to achieve a Bispectral Index (BIS) between 40 and 60, can be used for maintenance 1, 3.
- Analgesia: Fentanyl 1-2 mcg/kg or remifentanil 0.1-0.2 mcg/kg/min, supplemented with ketorolac 15-30 mg or acetaminophen 1000 mg as needed, can be effective 1, 2.
- Local Anesthesia: Bupivacaine 0.25% or ropivacaine 0.2% for port sites and the hernia repair area can reduce postoperative pain 1.
- Postoperative Pain Management: A combination of acetaminophen 1000 mg every 6 hours, ibuprofen 400-600 mg every 6 hours, and oxycodone 5-10 mg every 4 hours as needed can be used 2, 3.
Monitoring and Tailoring the Anesthesia Plan
Monitoring should include standard ASA parameters, with careful attention to ventilation, oxygenation, and hemodynamics due to the potential for CO2 absorption and increased intra-abdominal pressure during laparoscopy 2, 3. It is essential to tailor the anesthesia plan to the individual patient's medical history, physical status, and the specific requirements of the surgical procedure 1, 2, 3.
Multimodal Analgesia Approaches
Using multimodal, opioid-sparing analgesia approaches can improve postoperative recovery 1. This may include the use of lidocaine, dexmedetomidine, ketamine, and magnesium as part of opioid-free anesthesia, which may have better anti-inflammatory effects than classical opioid-based anesthesia 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also reduce opioid consumption, but their use should be balanced against potential side effects 1.
From the Research
Anesthesia Considerations for Laparoscopic Ventral Hernia Repair
- The feasibility of spinal anesthesia in laparoscopic ventral hernia repair has been studied, with results showing that it is a viable option 4, 5.
- Spinal anesthesia has been found to be well tolerated, with minimal postoperative pain and smooth recovery 5.
- The use of local anesthesia, such as bupivacaine and fentanyl, has also been explored, with studies showing a decrease in postoperative pain scores 4, 6.
- Intraoperative incidents and complications have been found to be minimal, with no conversions to general anesthesia required in some studies 5.
- Postoperative pain management is crucial, with studies showing that pain scores can be significant, especially during activity 7.
- The use of multimodal techniques, such as preoperative Botulinum Toxin A injection, laparoscopic anterior components separation, and open mesh repair, has also been described 8.
Key Findings
- Spinal anesthesia is a feasible and well-tolerated option for laparoscopic ventral hernia repair 4, 5.
- Local anesthesia can reduce postoperative pain scores 6.
- Postoperative pain management is essential to improve patient outcomes and quality of life 7.
- Multimodal techniques can be effective in reducing complications and improving outcomes 8.