Abstract
Objective: To compare levobupivacaine based caudal epidural anesthesia and spinal anesthesia in terms of Intraoperative hemodynamic changes and postoperative pain and patient comfort in subjects undergoing perianal surgery in outpatient setting. Material and methods: All consecutive patients who were scheduled for perianal surgery. The difference in intraoperative hemodynamic changes, sensory and motor block level, postoperative pain and patient comfort was the primary outcome measure of this study. Results: There were no significant differences between the groups in terms of mean arterial pressure and heart rate recorded. Subjects randomized to spinal anesthesia had a significantl extensive motor and sensory block compared to those randomized to caudal epidural anesthesia. Visual analogue scale scores for surgical pain at postoperative 12 hours was significantly higher in subjects receiving spinal anesthesia compared to those receiving caudal epidural anesthesia (p< 0.05). Time to first analgesic administration was significantly lower in subjects randomized to spinal anesthesia compared to those receiving caudal epidural anesthesia (p< 0.01). Conclusion: Spinal anesthesia is associated with more extensive sensory and motor block compared to caudal epidural anesthesia in patients undergoing perianal surgery. Both techniques lead to similar hemodynamic changes. Postoperative pain control is more favorable with caudal block than the spinal anesthesia.
Highlights
Advances in anesthetic and surgical techniques led to an increase in outpatient surgical procedures
After the local ethic committee approval 70 patients aged ≥ 18 years, and were American Society of Anesthesiologists (ASA) class I-II, who were scheduled for perianal surgery for perianal abscess, perianal fistula, hemorrhoids, and anal fissures were included in this study
Twelve patients who did not meet the inclusion criteria were excluded, and total of 58 patients were studied as caudal epidural anesthesia (n=28) or spinal anesthesia (n=30)
Summary
Advances in anesthetic and surgical techniques led to an increase in outpatient surgical procedures. Performing several surgeries in outpatient setting reduces healthcare costs and increases patients’ satisfaction due to same day discharge after the procedure [1]. Local anesthesia, and regional anesthesia techniques have traditionally been used in anesthesia management of patients undergoing perianal surgery [6,7]. Perianal surgery with local anesthetic infiltration requires concomitant sedation which can reduce patient comfort [10,11,12]. Regional anesthetic techniques might be unique for use in perianal surgery since spontaneous breathing is prevented, preventative reflexes remained active, and subjects are often mobilized in early postoperative period
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