Expert: Ronald Levy, M.D. - 4/14/2009

Question
My husband has an inguinal hernia and he went to see a surgeon today because he wants it repaired. The surgeon
told him he would do general surgery and give him twilight and a local and the surgery would take an hour and a half.
I just assumed he would be given a general anesthesia. My husband gets very anxious when he has things like this done and I wonder why the surgeon is doing the surgery this way. Also, do you know what he meant by twilight?

Thank you.  

Answer
Inguinal hernias can be done many ways, general, spinal or local. Each has advantages and disadvantages.

General: Advantages are pt is asleep, doesn't know anything, easiest for surgeon. Disadvantages: pt cannot control own vital signs and perhaps breathing, surgeon can't have pt. bear down to test repair.

Spinal: Adv: pt feels no pain and gets good analgesia for a few hours post surgery. Pt controls own vitals and can report things like chest pain, etc. Can cough to test repair. Disadv: Pt is awake (or partially awake), can't move legs for an hour post surgery so may have delayed discharge.

Local: Adv: Pt. can bear down, can control vitals, earlier discharge from OR/hospital. Disadv: pt is awake (or partially awake), may feel groggy for rest of day.

All of these techniques are reasonable. The general philosophy is the less anesthetic the better for the patient. Twilite means deep sedation but still arousable. Probably will not remember the surgery at all.

I hope this answers your question,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston