A 45 year-old man was admitted to the same day surgery for repair of a direct inguinal hernia. A spinal anesthetic was administered, which was of sufficient level and duration to encompass the analgesic requirement for surgery.

 After the spinal was given and surgery started, the anesthetist asked the patient if he wished to be sedated.

 At first he refused, but as the procedure progressed he began to feel visceral traction as the hernia sac was opened.

 There was no somatic pain, but the abdominal irritation led the patient to ask for a sleep-producing medication.

case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center
case editor: Michael Gordon, Ph.D.