Local anesthetic infiltration versus caudal epidural block for anorectal surgery: a randomized controlled trial

Abstract

Study objective: To compare patient satisfaction with local anesthetic infiltration versus caudal epidural block for anorectal procedures.

Design: Randomized controlled trial.

Setting: Operating room and postanesthesia care unit (PACU).

Patients: 22 adult, ASA physical status I, II, and III patients scheduled for anorectal surgery.

Interventions: Patients were randomized to receive either local anesthetic infiltration (LAI) (n = 10) by the surgeon or caudal epidural block (CEB) (n = 12) by the anesthesiologist.

Measurements: The primary outcome was patient satisfaction with the anesthetic technique and pain relief 12 hours after the procedure on a 4-point Likert scale. Secondary outcomes included time to first analgesic request, time to reach a PACU discharge score (REACT score) of 10, time to ambulation, time to discharge home, and adverse events.

Main results: More subjects in the CEB group (83.3%) were highly satisfied than in the LAI group (20%; P = 0.003), assessed 12 hours postoperatively by telephone interview. Subjects in the CEB group requested analgesia 423 minutes later (95% confidence interval, 286-560 min) than subjects in the LAI group. Differences in time to reach a REACT score of 10, time to ambulation, and time to discharge home were not statistically significant.

Conclusions: Caudal epidural block provides higher patient satisfaction and longer lasting analgesia than LAI without delaying discharge.