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Day Case Hernia Repair — FRCA Final MCQ

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ModerateDay SurgeryDay Case Hernia RepairFRCA Final

A 45-year-old man who is ASA I is scheduled for an uncomplicated unilateral open inguinal hernia repair as a day case. Which anaesthetic technique is most likely to provide reliable operating conditions while facilitating prompt same-day discharge?

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Correct answer: A — Short-acting general anaesthesia via a supraglottic airway with surgical local anaesthetic infiltration

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

E is the best option. Short-acting general anaesthesia via a supraglottic airway provides reliable operating conditions, while local infiltration reduces postoperative pain, opioid use and associated nausea, supporting early mobilisation and discharge. Routine morphine PCA in A is incompatible with an opioid-sparing day-case pathway. Option B gives 15 mg hyperbaric bupivacaine, whose prolonged motor block may delay mobilisation. The isolated blocks in C do not provide the comprehensive field anaesthesia required for a reliable open repair without additional infiltration. In D, 1 ml of 2% prilocaine contains only 20 mg (20 mg/ml × 1 ml), below the SmPC's usual 40–60 mg dose for a T10 block; intrathecal fentanyl may also add pruritus, nausea and urinary retention.

Reference: Radwan RW et al. Benefits of pre-emptive analgesia by local infiltration at day-case general anaesthetic open inguinal hernioplasty. Ann R Coll Surg Engl. 2018. https://rcoa.ac.uk/node/18556