Options for Post Operative Local Anesthetics

Local anesthetics are best way to control pain after surgery. There are very few side effects and the pain often can be completely eliminated, not just covered up with pain pills.  They work by blocking the signals that nerves send back to the brain.


Lidocaine is the most common of the local anesthetics. It has very rapid onset, but only lasts for a few hours. It is very safe medication as long as dose is kept less than 300mg. The most common serious complications are cardiac and central nervous system. This is great anesthetic for operations where there will be very little pain after the operation. For example, removing a skin lesion.

Ropivacaine and Bupivacaine

Ropivacaine and Bupivacaine last much longer than Lidocaine and thus are much more helpful in surgical patients.  If injected into the tissues, they will work for about 8 hours.  If injected around a nerve, then they will often last for 16 hours. Robivacaine has less cardiac toxicity than Marcaine, but Marcaine is a more effective. The most serious complications from these medications are cardiac and central nervous system.  It is best not to exceed using more than 225 mg of either medication.  Adding epinephrine or decadron to the Ropivacaine or to the Bupivacaine will increase the duration of pain control.  When injecting around a nerve, the preservative free medications are the best.

Bupivacaine Liposome

Bupivacaine liposome (Exparel) is bupivacaine mixed with a lipid. The lipid releases the bupivacaine slowly and thereby prolongs the effectiveness.  The slow release  also decreases the risk of cardiac or central nervous system toxicity.  If injected into the tissues, it will work for about 12 hours.  If injected around a nerve, then it will often last for 30 hours. The major downside to Exparel is the price. It costs about $225 a dose.

Dr. Brown and his staff are available to answer your questions and address concerns you might have about your inguinal hernia diagnosis or surgical repair options. Contact them for more information.

William Brown, MD
Hernia Specialist

Dr. Brown has been repairing inguinal hernias for over 30 years, taking care of Athletes with Sports Hernia injuries since 1999.  Dr. Brown has been taking care of patients with complications from mesh for so long that his hair is gray. Luckily he still has some hair.

His patients include players from the San Jose Sharks and the San Jose Earthquakes as well as athletes from the NFL, AFL, NBA, and the local college teams. As well as Athletes from 15 foreign countries.

Fremont Office
William H. Brown, M.D.
39470 Paseo Padre Pkwy
Fremont, CA 94538
(510) 793-2404
Fax: (510) 793-1320

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