Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure

Abstract

-Context -Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure. Objectives -Randomized clinical trial to compare the results from these two techniques. Methods -Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25) and using local anesthesia (n = 25). Preoperatively, the bowel was evaluated by means of colonoscopy, and bowel preparation was performed with 10% oral mannitol solution and physiological saline solution for lavage through the distal colostomy orifice. All patients were given prophylactic antibiotics (cefoxitin). Pain, analgesia, reestablishment of peristaltism or peristalsis, diet reintroduction, length of hospitalization and rehospitalization were analyzed postoperatively. Results -Surgery duration and local complications were greater in the spinal anesthesia group. Conversion to general anesthesia occurred only with spinal anesthesia. There was no difference in intraoperative pain between the groups, but postoperative pain, reestablishment of peristaltism or peristalsis, diet reintroduction and length of hospitalization were lower with local anesthesia. Conclusions -Local anesthesia plus sedation offers a safer and more effective method than spinal anesthesia for loop colostomy closure. HEADINGS -Anesthesia, spinal. Anesthesia, local. Colostomy.There were no conflicts of interest in the present research.

Comparison of Postoperative Analgesia in Patients Undergoing Ileostomy Closure With and Without Dual Transversus Abdominis Plane (Tap) Block– A Randomized Controlled Trial

“…Abreu et al found that problems like postdural puncture headache, urinary retention, and ileus were more often encountered in patients undergoing IC with subarachnoid block. 25 There are a few limitations to our study. The block was performed after the surgery.…”

Comparison of Postoperative Analgesia in Patients Undergoing Ileostomy Closure with and Without Dual Transversus Abdominis Plane (TAP) Block: A Randomized Controlled Trial

“…For this reason, we hypothesized that a dual TAP block would provide comprehensive unilateral analgesia after IC. Abreu et al found that problems like postdural puncture headache, urinary retention, and ileus were more often encountered in patients undergoing IC with subarachnoid block 25…”

How to do a trephine colostomy under spinal anaesthesia

“…The option of raising a trephine colostomy in a medically unfit patient without general anaesthesia is likely to become more necessary as we deal with an increasingly elderly population. Although previous studies have demonstrated the feasibility of reversing loop ileostomy and colostomy under spinal and local anaesthesia, these patients had all recently had general anaesthesia which is not always an option in high‐risk patients. Furthermore, this technique could potentially be offered to other patients as an alternative to the conventional method.…”