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Randomized Controlled Trial
. 2023 Nov-Dec;73(6):725-735.
doi: 10.1016/j.bjane.2023.05.002. Epub 2023 May 27.

Effectiveness and safety of ultra-low-dose spinal anesthesia versus perineal blocks in hemorroidectomy and anal fistula surgery: a randomized controlled trial

Rafael Peterson Soares Santos  1 , Alfredo Dias de Oliveira-Filho  2 , Manoel Álvaro de Freitas Lins Neto  3 , Lucas Correia Lins  3 , Fabiano Timbó Barbosa  4 , Sabrina Joany Felizardo Neves  2
Affiliations
Randomized Controlled Trial

Effectiveness and safety of ultra-low-dose spinal anesthesia versus perineal blocks in hemorroidectomy and anal fistula surgery: a randomized controlled trial

Rafael Peterson Soares Santos et al. Braz J Anesthesiol. 2023 Nov-Dec.

Abstract

Background: Ultra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB).

Methods: A two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes.

Results: Fifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354).

Conclusion: SA and PB are similarly effective in pain control during the first 48 h after hemorrhoidectomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol.

Keywords: Anal fistula; Hemorrhoidectomy; Outpatient surgery; Spinal anesthesia; Urinary retention.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram based on the Consolidated Standards of Reporting Trial (CONSORT) statement.
Figure 2
Figure 2
Incidence of pain (%) subdivided into categories in all surgeries, in hemorrhoidectomy and in anal fistula surgery; p-value (Pearson Chi-Square). Minor pain: VAS = 1 to 3. Major pain: VAS = 4 to 10. VAS, visual analog scale.
Figure 3
Figure 3
Average Mean Arterial Pressure – MAP (mmHg) and Heart Rate – HR (bpm) in all surgeries, hemorrhoidectomy, and anal fistula surgery.
See this image and copyright information in PMC

References

    1. Shaw D, Ternent CA. Perioperative management of the ambulatory anorectal surgery patient. Clin Colon Rectal Surg. 2016;29:7–13. - PMC - PubMed
    1. Ternent CA, Fleming MDF, Welton MDML, Buie WD, Steele MDS, Rafferty MDJ. Clinical practice guideline for ambulatory. Dis Colon Rectum. 2015;58:915–922. - PubMed
    1. Vinson-Bonnet B, Higuero T, Faucheron JL, Senejoux A, Pigot F, Siproudhis L. Ambulatory haemorrhoidal surgery: systematic literature review and qualitative analysis. Int J Colorectal Dis. 2014;30:437–445. - PubMed
    1. Kowalik MK. Plante, urinary retention in surgical patients. Surg Clin North Am. 2016;96:453–467. - PubMed
    1. Borges LA, Leal PC, Moura ECR, Sakata RK. Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy. Sao Paulo Med J. 2017;135:247–252. - PMC - PubMed

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