Abstract
Background and Objective. This study aimed to compare the effects of different local anesthetic solutions on postoperative pain of anal surgery in adult patients. Method. In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old) with physical status class I and class II that had been brought to a university hospital operating room for fistula anal surgery with spinal anesthesia were selected. Patients were randomly divided into 4 equal groups according to table of random numbers (created by Random Allocation Software 1). Group 1 received 3 mL of normal saline, group 2, 1 mL of normal saline plus 2 mL of bupivacaine 0.5%, group 3, 1 mL of ketamine plus 2 mL of bupivacaine 0.5%, and group 4, no infiltration. Intensity of pain in patients was measured using visual analogue scale (VAS) at 0 (transfer to ward), 2, 6, 12, and 24 hours after surgery. Time interval to administration of drugs and overall dose of drugs were measured in 4 groups. Results. Mean level of pain was the lowest in group 3 at all occasions with a significant difference, followed by groups 2, 4, and lastly 1 (P < 0.001). Furthermore, groups 2 and 3 compared to groups 1 and 4 had the least overall dose of analgesics and requested them the latest, with a significant difference (P < 0.05). Conclusion. Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5%) combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients.
Highlights
Anorectal diseases affect nearly 5% of the adult population [1]
This randomized double-blind prospective clinical trial was conducted on 60 adult patients (18- to 60-year-old) with physical status class I and class II, candidate for nocomplicated fistula repair surgery under spinal anesthesia in Imam Khomeini Hospital over one year (2010-2011)
Many studies have so far investigated the effect of adding local ketamine injection to local anesthetics; for instance, Dal et al [10] showed that local injection of ketamine in children undergoing adenotonsillectomy significantly reduced pain score, dose of rescue analgesia, and increased time interval to the first dose of opiate compared to the group receiving IV normal saline
Summary
Anorectal diseases affect nearly 5% of the adult population [1]. Anal fistula is a common anorectal problem and complaint of more than 10% of visits to anorectal clinics [2]. Fistula surgery can be performed under general, spinal, or local anesthesia [3]. This study aimed to compare the effects of different local anesthetic solutions on postoperative pain of anal surgery in adult patients. In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old) with physical status class I and class II that had been brought to a university hospital operating room for fistula anal surgery with spinal anesthesia were selected. Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5%) combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients
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