Do They Put You to Sleep for Hernia Surgery?

Often, but not always. Keyhole repairs and hiatal hernia repairs are almost always done under general anesthesia, which means you’re fully asleep. Many open groin hernia repairs, though, can be done with numbing medicine plus sedation, so you’re relaxed or drowsy but not unconscious.¹ Specialist hernia centres use the awake-with-numbing approach in nearly all of these repairs, even though many hospitals still default to putting patients to sleep.²

The Three Main Ways Hernia Surgery Is Numbed

General anesthesia: medicine makes you fully unconscious, and a breathing tube or mask supports your breathing.
Spinal anesthesia: an injection in the lower back numbs you from the waist down for a few hours while you stay awake or lightly sedated.³
Local anesthesia with sedation: numbing medicine is injected around the hernia, usually alongside sedation through a drip.⁴

Before any of these, you get an IV line in your hand or arm, and the team attaches monitors for your heart rate, blood pressure and oxygen level. With general anesthesia, the medicine usually goes through the IV and you drift off within a minute or two, so the last thing you remember is the operating room, not the surgery. With numbing or a spinal, the anesthetist usually gives a little sedation first so the injection is easier to tolerate. The numbing injections sting briefly, like a dental injection, and then the area goes dull. A spinal is easy to confuse with an epidural. A spinal is a single injection that works within minutes. An epidural uses a thin tube and is mainly for longer pain relief. For hernia repair, a spinal is the usual back injection.

Sedation sits between awake and asleep. You’re drowsy and calm, may doze, and often remember little afterward, but you keep breathing on your own. In a controlled trial, adding sedation to local numbing gave higher satisfaction and less pain than numbing alone.⁵

You may feel pressure or tugging, but not sharp pain. The team talks to you and can add more numbing if you feel anything, and you may be asked to cough so the surgeon can check the repair. A drape blocks the view, so you won’t see the operation. If you feel anxious, you can say so and the team will increase the sedation.

After general anesthesia, you wake in the recovery area, usually remembering nothing between falling asleep and waking. A sore throat is common if a breathing tube was used, and it fades within a day or two. Grogginess, a dry mouth and some nausea are common at first, and the team can give medicine for the nausea. Your thinking can stay slightly fuzzy for the rest of the day, so don’t make big decisions or sign papers that day.

Which Option Fits Your Type of Hernia

The choice depends on the hernia’s type, size and location, and on whether bowel is trapped or its blood supply is cut off.⁶

Keyhole surgery works through small cuts while the belly is inflated with gas. Inflating the belly is uncomfortable and works best with relaxed muscles, so general anesthesia is standard.⁷ Being fully asleep with a machine controlling your breathing is also the standard way to handle the gas that gets absorbed during the operation.⁸

Open groin repair through one cut is where you may have a choice. It’s suitable for local anesthesia and is economical.⁹ In Japan, this repair is widely done under local anesthesia.¹⁰ Keyhole is often considered for hernias on both sides or ones that have come back, since the surgeon can fix both from the same incisions. If you’re keen to avoid being asleep, ask whether open repair is reasonable for your hernia.

Hiatal hernia repair is most often done under general anesthesia.¹¹ A hiatal hernia is the stomach pushing up through the opening in the diaphragm, so it sits at the chest-belly junction rather than in the groin. The surgery happens near the diaphragm, your main breathing muscle, and the food pipe, so you need to be completely still and relaxed. Most are repaired by keyhole surgery, which is another reason being asleep is the norm.

A trapped hernia that has lost its blood supply is an emergency. Such cases are usually handled with general anesthesia, sometimes combined with an epidural for pain control.¹²

Small belly-button hernias are often repaired openly and may be done with local numbing. Large or repeat hernias in the belly wall usually mean general anesthesia. To find out which approach you’re getting, check your surgery booking or consent form, which usually says open or laparoscopic (keyhole).

Does Staying Awake Change Your Recovery

Local anesthesia was linked to roughly 20 minutes less in the recovery room than general anesthesia, at every age.¹³ With numbing plus sedation and a nerve block, people were ready to go home in about 2 hours, versus nearly 3 hours after general and over 4 and a half after a spinal.¹⁴ That approach also brought lower pain at discharge and higher next-day satisfaction.¹⁵

In the recovery area, nurses check your breathing, blood pressure, pain and the wound. The question is when you’re alert and comfortable enough, and able to drink and pass urine, to be discharged. After general anesthesia, nausea and drowsiness are the usual hold-ups. After a spinal, it’s waiting for feeling and movement to return to your legs, which numb for hours. A spinal can also make passing urine harder, so staff often want you to pee before you leave. That’s why it can keep you in longer than being asleep or numbing alone, even though it avoids a breathing tube.

Side effects differ too. Nausea, vomiting, sore throat and pain needing treatment in the first day were less common with a nerve block than with general anesthesia.¹⁶ Open repair under local with sedation has shown low complications and few hernia returns over 1.5 years.¹⁷ Some people worry an awake repair is less thorough, but the surgeon does the same repair regardless of anesthesia. Good results depend more on technique and surgeon experience.

After numbing with sedation, you can usually have something to drink and eat soon after, since you weren’t fully asleep. After being fully asleep, you start with sips and light food and wait until the nausea settles. Walking soon after surgery is encouraged either way, with someone beside you the first time you stand. Most groin repairs go home the same day, and you’ll need a ride and an adult with you overnight whichever option you have.

Side Effects to Know About With a Spinal

Compared with being asleep, a spinal raised the risk of being unable to pee after surgery and of headache.¹⁸ That extra risk showed up clearly mainly in keyhole repairs.¹⁹ In men over 50 given a spinal for groin repair, about 1 in 6 needed a tube to drain the bladder.²⁰ A prostate medicine taken around surgery did not clearly prevent it.²¹

A spinal blocks the nerves that control the bladder along with those for the legs, so the bladder may not empty properly. You may feel a full, uncomfortable bladder but be unable to pass urine. The effect wears off as the spinal does, which is why the problem is usually temporary. Nurses check with a quick bladder scan before you leave, and a short-term tube usually solves it, though you go home later.

Men, especially older men with an enlarged prostate or a weak stream, are more likely to have trouble. Having had trouble peeing before, and getting a lot of IV fluid during surgery, can add to the chance. Tell the team about your urinary symptoms before surgery so they can plan for it.

A spinal headache worsens when you sit or stand and eases lying down. Fluids, rest and pain relief usually help. Call the hospital if it lasts more than a day or two.

Nerve Blocks for Pain After Surgery

A nerve block is an injection, usually guided by ultrasound, that numbs the nerves supplying the surgical area. People given a block had less pain at rest and when moving after groin repair.²² With a groin nerve block added to a spinal, the first request for painkillers came about 6 hours after surgery rather than 3.²³

The anesthetist uses an ultrasound probe on the skin to see the nerves and tissue layers near the hernia. A small needle is guided next to the nerves and numbing medicine is injected, and you may feel pressure or a brief sting. It can be given before surgery, after numbing, or while you’re asleep, so you don’t have to be awake for it. When it works, the groin and nearby skin feel numb or heavy. Your leg strength is usually not affected the way it is with a spinal, though the team will check before you walk. The effect fades gradually over several hours.

The same block cut opioid use in the first day to about a third.²⁴ A belly-wall block also lowered opioid needs after groin repair.²⁵ Pain usually peaks with movement around the first day after surgery.²⁶

Ask your anesthetist whether a block is planned. A block wears off within hours, so take your pain pills before it does. At home, regular non-opioid painkillers are often enough. Get up and walk gently but avoid lifting, and press a pillow to your groin when coughing.

Older Adults and People With Health Problems

Guidelines recommend local anesthesia for groin repair in older adults because of less post-surgery confusion and better recovery of function.²⁷ In people 75 and over, complications fell from about 2.1% with general anesthesia to 1.6% with local.²⁸ Local with sedation also suits people with other illnesses or who want to avoid general anesthesia.²⁹

After general anesthesia, some older people are muddled, forgetful or unusually drowsy, or have trouble following a conversation, for days afterward. It can come and go during the day, and family members often spot it before the patient does. It’s more likely in people who already have memory problems, so mention any memory concerns at the pre-op visit.

For people with heart or lung disease, the aim is to avoid the stress of general anesthesia and a breathing tube where possible. Numbing with sedation can leave you breathing on your own, which suits many people with lung conditions. The anesthetist weighs your condition, medicines and the type of repair, so the best option can still differ from one person to another.

At your pre-op visit, ask whether a nerve block will be used and what happens if you need to switch to general during surgery.

What Happens for Children

There’s no single standard anesthesia for infant groin hernia repair. Options range from a spinal or lower-back block with sedation to general anesthesia.³⁰ In one hospital, a lower-back block with sedation let 9 in 10 infants finish surgery without being put to sleep.³¹ Protocols that add nerve blocks have cut opioid use after children’s hernia repair from about half to about 1 in 6.³²

Most children, especially those past infancy, are put to sleep, because staying calm and completely still on an operating table is a lot to ask of them. Being asleep also spares a child the sight and sounds of the operating room, which can be frightening. Anesthetists trained for children use child-specific techniques, often starting with gas through a mask. Ask whether a block will be used for pain afterward. Children often wake up upset briefly, and that passes.

Some young infants are candidates for a lower-back block with light sedation, because they can lie still and the block numbs the lower body. Anesthetists sometimes consider this for babies who may have a higher risk from general anesthesia, such as those born early. It isn’t suitable for every infant, and which approach is used varies between hospitals.

On the day, follow fasting times exactly or surgery may be postponed. Bring a comfort item for waking up. Most children go home the same day.