Local Perianal Anesthetic Infiltration Is Safe and Effective for Anorectal Surgery

Abstract

Background: General or regional anesthesia is predominantly used for anorectal surgery, however in the recent years more attention was drawn in the use of local anesthesia for anorectal surgery. In this study we present the technique and results of the use of local perianal anesthetic infiltration for minor anorectal operations.Methods: In this cohort study patients undergoing surgery for hemorrhoids, anal fissures and low anal fistulas were included. Posterior perineal block was induced with a mixture containing 0.125% bupivacaine and 0.5% lidocaine. All patients were followed up at 30 days either by a post-operative visit or a telephone call and all post-operative complications over the post-operative 30-day period were registered.Results: One thousand and twenty-six consecutive patients were included in our study. For all patients' intraoperative analgesia was achieved after performing perianal anesthetic infiltration and no additional support from the anesthesia team was necessary in any of case. Complications were observed in 14 (1.4%). Urinary retention occurred in 5 (0.5%) cases. Six cases of bleeding occurred after hemorrhoidectomy (0.6%) and 1 (0.1%) after lateral internal sphincterotomy. Perianal abscess developed for two patients (0.2%).Conclusions: Local anesthesia using posterior perineal block technique is safe and effective for intraoperative analgesia in anorectal surgery, saving a substantial operation cost by avoiding the involvement of an anesthesia team and resulting in minimal incidence of urinary retention and other complications.

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“…Patients were positioned in the jack-knife prone position and then administered intravenous general anesthesia. Local anesthesia, comprising bupivacaine 0.5% (20 ml), lidocaine 2% (20 ml), and distilled water (10 ml), was injected peripherally to the external sphincter of each quadrant [8,9]. A proctoscope was inserted to facilitate the careful grasping of hemorrhoid tissue using long, smooth forceps (Fig.…”

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“…In cases of large symptomatic perianal thrombosis, thrombectomy may be performed, ideally under local anesthesia (57). Also, surgical interventions in the presence of internal hemorrhoid thrombosis are not recommended, because of increased anal sphincter damage, and the increased risk of anal stenosis.…”

Letter to the Editor Regarding “Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial”

“…More complex fistulas involving more sphincters can be treated with rectal advancement flap, intersphincter fistula ligation (LIFT), fibrin glue, fistula plug, cutting or drainage sleeve (rubber band) [ 3 ]. And in a cohort study in 2021, Poskus et al [ 4 ] reported 1026 patients undergoing anorectal surgery for hemorrhoids (835), anal fissures (15), low anal fistulas (162), and anal polyps (14). There were six cases (0.6%) of bleeding after hemorrhoidectomy and one case (0.1%) of bleeding after lateral internal sphincterotomy.…”

“…There were six cases (0.6%) of bleeding after hemorrhoidectomy and one case (0.1%) of bleeding after lateral internal sphincterotomy. Perianal abscess occurred in two patients (0.2%): one after hemorrhoidectomy and the other after sphincterotomy [ 4 ]. Different surgical methods involve different nerves.…”