BACKGROUND: Evidence suggests that switch from spinal/general anaesthesia (SA/GA) to perianal block (PAB) may prove advantageous for proctologic surgeries. This study evaluates the practicability of this evidence based switch. METHODS: Feasibility and efficacy of PAB for proctologic surgeries was prospectively evaluated on 100 consecutive patients over 11 months. Thirty ml of local anesthetic (0.25% bupivacaine+1% lignocaine with adrenaline) was infiltrated into the anal sphincter and perianal skin, under sedation, for achieving PAB. Time taken for onset of anesthesia; success/failure of block; conversion rate to GA; operative ease; operative time; post operative recovery; duration of analgesia; post operative pain based on verbal response score (VRS; scale: 0-100); and complications were analyzed. RESULTS: 54 open haemorrhoidectomies; 27 fistulectomies and 19 lateral sphincterotomies were performed. Average of 3 min (range 2-5 min) was needed for onset. Block was successful in 97% of cases. 3% needed conversion to GA. Good anesthesia and sphincter relaxation ensured operative ease. Median operative time was 20 min (range 10-35 min). Analgesia lasted a median of 5 hours (range 3-10 hrs). Subsequent pain ranged between VRS 10-40, tapering off, along with analgesic requirement, over a week. Trivial injection site hematoma (1%) and reactionary bleeding (1%) were the complications observed. Post operative recovery was uniformly smooth in all patients. CONCLUSIONS: Perianal block is a safe, feasible, reliable, and reproducible mode of anesthesia for ano-rectal surgeries. Its evident efficacy justifies its adoption as anesthesia of choice. Copyright 2009 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
BACKGROUND: Evidence suggests that switch from spinal/general anaesthesia (SA/GA) to perianal block (PAB) may prove advantageous for proctologic surgeries. This study evaluates the practicability of this evidence based switch. METHODS: Feasibility and efficacy of PAB for proctologic surgeries was prospectively evaluated on 100 consecutive patients over 11 months. Thirty ml of local anesthetic (0.25% bupivacaine+1% lignocaine with adrenaline) was infiltrated into the anal sphincter and perianal skin, under sedation, for achieving PAB. Time taken for onset of anesthesia; success/failure of block; conversion rate to GA; operative ease; operative time; post operative recovery; duration of analgesia; post operative pain based on verbal response score (VRS; scale: 0-100); and complications were analyzed. RESULTS: 54 open haemorrhoidectomies; 27 fistulectomies and 19 lateral sphincterotomies were performed. Average of 3 min (range 2-5 min) was needed for onset. Block was successful in 97% of cases. 3% needed conversion to GA. Good anesthesia and sphincter relaxation ensured operative ease. Median operative time was 20 min (range 10-35 min). Analgesia lasted a median of 5 hours (range 3-10 hrs). Subsequent pain ranged between VRS 10-40, tapering off, along with analgesic requirement, over a week. Trivial injection site hematoma (1%) and reactionary bleeding (1%) were the complications observed. Post operative recovery was uniformly smooth in all patients. CONCLUSIONS: Perianal block is a safe, feasible, reliable, and reproducible mode of anesthesia for ano-rectal surgeries. Its evident efficacy justifies its adoption as anesthesia of choice. Copyright 2009 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.