# A Pilot Study of Local Anesthesia for Inguinal Hernia Surgery in Older Adults

> **NIH NIH K76** · UT SOUTHWESTERN MEDICAL CENTER · 2021 · $246,204

## Abstract

Inguinal hernia repair – the most common general surgery operation in the U.S. – provides a unique
opportunity to improve outcomes for older adults by changing surgical practice. Nearly 80% of inguinal hernia
operations are performed under general anesthesia versus 15%-20% using local anesthesia. Although some
studies suggest that exposure to general anesthesia can cause cognitive and physical decline in older adults,
the evidence for choosing an anesthesia technique for inguinal hernia repair in older adults is inconclusive.
Several studies demonstrated that using local anesthesia for hernia repair reduced morbidity by one-third,
unplanned admissions by 20%, and operative time and costs by 15%, while other studies showed no
significant differences. Unfortunately, these studies have significant shortcomings that limit their applicability for
older adults. In particular, prior studies mostly involved younger and healthier patients, with no analysis of
whether potential benefits of local anesthesia were greater in older adults. We conducted the first large,
population-based study that evaluated how local and general anesthesia affect outcomes in older adults. Using
an instrumental variable approach to analyze a large retrospective cohort of older adults, we identified a strong
association between local anesthesia and improved intra-, peri-, and postoperative outcomes. This proposal is
the next logical step toward verifying those findings in a multisite randomized clinical trial.
The applicant is an assistant professor in surgery whose long-term career goal is to integrate expertise in
implementation science and clinical trials to promote patient-centered outcomes for older adults before, during,
and after surgery. The project goal is to obtain preliminary data to inform design of a multisite randomized trial
comparing general versus local anesthesia for inguinal hernia repair in adults aged 65 years and older. We
hypothesize that using local rather than general anesthesia for inguinal hernia repair in older adults will
Aim 1: Identify patient-
centered outcomes to measure in a randomized clinical trial of local versus general anesthesia, and
evaluate how patient perceptions of hernia surgery affect anesthesia selection. Aim 2: Identify
potential barriers to use of local anesthesia and potential outcomes for a randomized trial from the
perspective of surgeons, anesthesiologists, and hospital leadership.
reduce morbidity and enhance quality of life. We propose the following specific aims:
Aim 3: Conduct a pilot
randomized study to assess and refine study procedures and determine feasibility of recruitment,
randomization, and retention for a multisite randomized trial of local versus general anesthesia in older
adults having inguinal hernia surgery. Expected outcomes of the study are (1) crucial preliminary data to
inform design of a multisite trial comparing local versus general anesthesia for hernia repair in older adults, and
(2) training in and kn...

## Key facts

- **NIH application ID:** 10327256
- **Project number:** 1K76AG068515-01A1
- **Recipient organization:** UT SOUTHWESTERN MEDICAL CENTER
- **Principal Investigator:** Courtney J Balentine
- **Activity code:** K76 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $246,204
- **Award type:** 1
- **Project period:** 2021-09-30 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10327256

## Citation

> US National Institutes of Health, RePORTER application 10327256, A Pilot Study of Local Anesthesia for Inguinal Hernia Surgery in Older Adults (1K76AG068515-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10327256. Licensed CC0.

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