Claus Anders Bertelsen1. 1. Department of Surgery, Hilleroed University Hospital, Hilleroed, Denmark. info@pilonidal.dk
Abstract
BACKGROUND: The use of tumescent local anesthesia in the Bascom cleft-lift procedure has not been described before. OBJECTIVE: This study aimed to find whether moderate to complex pilonidal sinuses could be treated using the cleft-lift procedure with local anesthesia, with only minor postoperative pain and brief sick leave. DESIGN: This is a prospective cohort study. SETTING: The study was conducted in a day-surgical department. PATIENTS: Eighty-three consecutive cleft-lift operations for pilonidal sinus were performed with tumescent local anesthesia. INTERVENTIONS: Tumescent local anesthesia with a saline water solution of 0.8 mg/mL mepivacaine and 0.001 mg/mL adrenalin buffered with sodium bicarbonate to pH 7.2 was infused subcutaneously. Seventy-five patients were interviewed daily by phone for 1 week to register their ability to return to work and to score their pain on a Numerical Rating Scale pain score from 0 (no pain) to 10. MAIN OUTCOME MEASURES: Outcome measures were the rate of conversion to general anesthesia, peri- and postoperative pain, and the times to discharge and to return to work. RESULTS: Eighty-two (99%) of the 83 procedures were performed with local anesthesia. In one patient, local was converted to general anesthesia. The mean maximum pain score experienced during the infusion was 3.7 (CI: 3.3-4.1), and during surgery, the score was 1.9 (CI: 1.4-2.3). Sixty-three (76%) of the patients were discharged directly from the operating room and 90% in less than an hour after the last stitch. The maximum pain after 2 days was none or mild (pain score ≤3) in 80% of the patients. Work could be resumed the next day by 35%, and after 4 days by 87% of the patients with a mean time of 3.0 (CI: 2.2-3.7) days. LIMITATIONS: This study might be limited by its noncomparative design. CONCLUSION: Most patients with moderate to complex pilonidal sinuses can be treated under local anesthesia without notable pain, and discharged minutes after the operation. The Bascom cleft-lift procedure causes only mild postoperative pain, and patients can resume work a few days later.
BACKGROUND: The use of tumescent local anesthesia in the Bascom cleft-lift procedure has not been described before. OBJECTIVE: This study aimed to find whether moderate to complex pilonidal sinuses could be treated using the cleft-lift procedure with local anesthesia, with only minor postoperative pain and brief sick leave. DESIGN: This is a prospective cohort study. SETTING: The study was conducted in a day-surgical department. PATIENTS: Eighty-three consecutive cleft-lift operations for pilonidal sinus were performed with tumescent local anesthesia. INTERVENTIONS: Tumescent local anesthesia with a salinewater solution of 0.8 mg/mL mepivacaine and 0.001 mg/mL adrenalin buffered with sodium bicarbonate to pH 7.2 was infused subcutaneously. Seventy-five patients were interviewed daily by phone for 1 week to register their ability to return to work and to score their pain on a Numerical Rating Scale pain score from 0 (no pain) to 10. MAIN OUTCOME MEASURES: Outcome measures were the rate of conversion to general anesthesia, peri- and postoperative pain, and the times to discharge and to return to work. RESULTS: Eighty-two (99%) of the 83 procedures were performed with local anesthesia. In one patient, local was converted to general anesthesia. The mean maximum pain score experienced during the infusion was 3.7 (CI: 3.3-4.1), and during surgery, the score was 1.9 (CI: 1.4-2.3). Sixty-three (76%) of the patients were discharged directly from the operating room and 90% in less than an hour after the last stitch. The maximum pain after 2 days was none or mild (pain score ≤3) in 80% of the patients. Work could be resumed the next day by 35%, and after 4 days by 87% of the patients with a mean time of 3.0 (CI: 2.2-3.7) days. LIMITATIONS: This study might be limited by its noncomparative design. CONCLUSION: Most patients with moderate to complex pilonidal sinuses can be treated under local anesthesia without notable pain, and discharged minutes after the operation. The Bascom cleft-lift procedure causes only mild postoperative pain, and patients can resume work a few days later.
Authors: V K Stauffer; M M Luedi; P Kauf; M Schmid; M Diekmann; K Wieferich; B Schnüriger; D Doll Journal: Sci Rep Date: 2018-02-15 Impact factor: 4.379
Authors: Dietrich Doll; Andriu Orlik; Katharina Maier; Peter Kauf; Marco Schmid; Maja Diekmann; Andreas P Vogt; Verena K Stauffer; Markus M Luedi Journal: Sci Rep Date: 2019-10-22 Impact factor: 4.379