Saddle block anesthetic technique for benign outpatient anorectal surgery

Peterson, Kristin; Dyrud, Paul; Johnson, Colin; Blank, Jacqueline J.; Eastwood, Daniel; Butterfield, Gail E.; Stekiel, Thomas A.; Peterson, Carrie Y.; Ludwig, Kirk; Ridolfi, Timothy J.

doi:10.1016/j.surg.2021.08.066

Cited by 4 publications

(9 citation statements)

References 28 publications

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“…This study included 50 patients randomly allocated into two equal groups of 25 patients each as shown in the Consort flow diagram. Three patients in the study were excluded because of failure to follow up figure (1).…”

Section: Resultsmentioning

confidence: 99%

“…It can be performed at a reduced cost compared with inpatient procedures with excellent safety, improved efficiency, and high levels of patient satisfaction. Several perioperative strategies are employed to control pain and avoid urinary retention, including the use of a multimodal pain regimen and restriction of intravenous fluids (1). Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions.…”

Section: Introductionmentioning

confidence: 99%

“…Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions. Multimodality pain management, including preemptive use of regional anesthesia and postoperative use of NSAIDs and acetaminophen, has improved pain control and decreased opioid requirements in different types of surgery (2). Gabapentin, a structural analog of gamma-aminobutyric acid, has been used as an anticonvulsant drug since the early nineties.…”

Section: Introductionmentioning

confidence: 99%

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A single preoperative dose of Gabapentin decreases postoperative pain in ambulatory anal surgeries

Mousa

Elwahab²,

Abdelrazik³

2023

Minia Journal of Medical Research

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Background: Anal surgeries are painful procedures despite advancements in postoperative pain management. Efficient post-surgical pain control is essential to patients' recovery, it may contribute to fastening healing, patient mobilization, and reducing hospital stays. We aimed to evaluate the effect of single-dose gabapentin on postoperative pain in patients who underwent ambulatory anal surgeries. Methods: Prospective, randomized, double-blind controlled study; 50 patients were divided into two equal groups. All patients underwent ambulatory anal surgeries under spinal anesthesia with a plan to be discharged on the same day. Group G received 600 mg of oral gabapentin one hour before surgery, while group C received an oral placebo tablet one hour before surgery. The primary outcome was the severity of postoperative pain (visual analog scale 0 to 10 cm) was conducted at 0, 6, and 12h. The time for the first analgesic request, frequency of rescue analgesia in the first 12 hours, and postoperative sedation (Ramsay sedation score) at 0, 6, and 12h were monitored as secondary outcomes. Results:The gabapentin group (G) showed significantly lower visual analog scale scores at 6, and 12 in comparison to the control group (C), and group G also showed a longer duration of analgesia and delayed analgesic rescue when compared with the control group. Ramsay sedation score showed insignificant differences between the two groups at 0, 6, and 12h postoperatively. Conclusions: A single preoperative gabapentin dose was effective in decreasing postoperative pain, prolonging the duration of analgesia, and decreasing the total opioid consumption, with no significant complications.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A single preoperative dose of Gabapentin decreases postoperative pain in ambulatory anal surgeries

Mousa

Elwahab²,

Abdelrazik³

2023

Minia Journal of Medical Research

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“…Although the advantages and disadvantages of general anesthesia and spinal anesthesia applications in ambulatory surgery are still an ongoing debate, the saddle block applied in anorectal surgery can be considered an attractive anesthesia method due to its very limited area of action. Studies show that the saddle block applied in anorectal surgery is an advantage as it provides adequate surgical anesthesia and limits the side effects associated with general anesthesia [7]. Patterson et al [7] provided satisfactory surgical anesthesia conditions in a study in which they analyzed the data of patients who applied hyperbaric bupivacaine or ropivacaine for anorectal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional anesthetic techniques for outpatient anorectal surgery may be compromised by a variety of issues, including prolonged onset, delayed offset, unreliability, and local anesthesia with intravenous sedation [6]. Saddle block anesthesia (SBA), a neuraxial technique, targets the distal sacral dermatomes to selectively block the perineum by intrathecal injection of local anesthetic while keeping the patient seated [4,7]. The spinal saddle anesthetic block has become the preferred method for perianal procedures, especially in high-volume day surgery facilities, because of additional characteristics such the quick onset, dense block, early patient ambulation, and a brief hospital stay [8].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Different Local Anesthetic Volumes for Saddle Block Anesthesia in Ambulatory Surgery: A Prospective Randomized Trial

Zengin,

Yalnız,

Başkan

et al. 2023

Cureus

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Introduction: Saddle block anesthesia (SBA) is a frequently preferred method for ambulatory anorectal surgery. This study aimed to observe the effects of two different dose SBAs on discharge times and perioperative block characteristics in patients undergoing ambulatory anorectal surgery.Methods: The study was conducted as a prospective, randomized controlled study. Patients over the age of 18 who were scheduled for ambulatory anorectal surgery and had American Society of Anaesthesiologists (ASA) physical status I and II were included in the research. Patients were divided into two groups: 5 mg hyperbaric bupivacaine 0.5% (Group I; n=34) and 3 mg hyperbaric bupivacaine 0.5% (Group II; n=34). The primary outcome was discharge time. Characteristics of the spinal block like time to reach S4 blockade, maximum blocked dermatome, regression time of sensorial, first analgesic need time, voiding time, mobilization time, and side effects were the secondary outcomes.Results: Sixty-eight patients were included in the study. The groups were similar in terms of demographic and surgical characteristics (p > 0.05). In Group II, S4 sensory dermatome blockade time was statistically longer (p: 0.007) and the time to the disappearance of the sensory block was statistically shorter (p < 0.001). Also, voiding time and discharge times were statistically shorter in Group II (p: 0.049, p < 0.001, respectively). Conclusion: SBA provided adequate anesthesia, and the complication rates were limited. Saddle block can be considered an advantageous technique because of conditions that adversely affect recoveries, such as postoperative cognitive problems, nausea, and vomiting due to general anesthesia. In addition, better recovery results and optimal surgical condition with 3 mg hyperbaric bupivacaine in our study suggest that this dose may be a good alternative.

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Prospects for the Application of Walkable Spinal Anesthesia Techniques in Surgery for Anorectal Diseases

赵¹

2023

ACM

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Saddle block anesthetic technique for benign outpatient anorectal surgery

Cited by 4 publications

References 28 publications

A single preoperative dose of Gabapentin decreases postoperative pain in ambulatory anal surgeries

A single preoperative dose of Gabapentin decreases postoperative pain in ambulatory anal surgeries

Comparison of Different Local Anesthetic Volumes for Saddle Block Anesthesia in Ambulatory Surgery: A Prospective Randomized Trial

Prospects for the Application of Walkable Spinal Anesthesia Techniques in Surgery for Anorectal Diseases

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