Tailored anal block (TAB): a new anesthesia procedure for surgical treatment of hemorrhoids in an outpatient setting

Elbetti, C.; Caminati, Filippo; I, Giani; Feroci, Francesco; Zalla, Tiku; Calussi, Marco; Dreoni, P.; Talamo, Giuseppina

doi:10.1007/s10151-019-01998-9

Cited by 8 publications

(8 citation statements)

References 3 publications

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“…Other studies also confirmed that patients have virtually no complications after posterior perianal block and that this anesthesia technique is easy to perform, can be safely applied by any surgeon, potentially reduce operation costs, is associated with a shorter hospital stay and ensure a faster patients return to full social activities (1,3,4,(12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 80%

Local Perianal Anesthetic Infiltration Is Safe and Effective for Anorectal Surgery

et al. 2021

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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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Section: Discussionmentioning

confidence: 80%

Local Perianal Anesthetic Infiltration Is Safe and Effective for Anorectal Surgery

et al. 2021

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“…Of them, 32 operations were performed in the operating room under spinal anesthesia and other 30 procedures were undertaken in the outpatient clinic under local anesthesia. Satisfactory local anesthesia was obtained with deep injection of ropivacaine 7.5% around the anus with a technique similar to that described by Elbetti et al 9 Procedures performed in the outpatient clinic were well tolerated without significant early or late side effects. The majority of patients had two hemorrhoidal cushions excised in both study groups, and it may be argued that removing three piles under local anesthesia could be too challenging.…”

Section: Discussionmentioning

confidence: 94%

“…However, there is an increasing number of proctological procedures that have been undertaken with local anesthesia in an outpatient setting. [7][8][9] Only a few reports 10,11 have evaluated the outcomes of open hemorrhoidectomy performed under local anesthesia and a definitive conclusion cannot be made.…”

Section: Introductionmentioning

confidence: 99%

Open Hemorrhoidectomy With Ligasure™ Under Local or Spinal Anesthesia: A Comparative Study

Feo

Ninniri

Tanda

et al. 2021

The American Surgeon™

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Background There is increasing evidence that many anorectal surgical procedures may be performed under local anesthesia. The aim of the present study was to evaluate the safety and efficacy of local anesthesia in the outpatient clinic vs spinal anesthesia in the operating room for open hemorrhoidectomy. Methods Sixty-two patients with grade III or IV hemorrhoids underwent open hemorrhoidectomy with LigaSure™ between 2018 and 2020. Of them, 32 procedures were performed in the operating room under spinal anesthesia with hyperbaric bupivacaine and other 30 procedures were undertaken in the outpatient clinic under local anesthesia with ropivacaine. Results There were no significant differences regarding age, gender, American Society of Anesthesiologists class, and Goligher’s grade in between groups. No significant differences were observed in postoperative pain score (P = .85), perioperative complications (P = .51), and reoperation rate (P = .96). No recurrences and no differences in patients’ satisfaction degree (P = .76) were documented at long-term follow-up in both study groups. Discussion Our results suggest that open hemorrhoidectomy with LigaSure™ performed in selected patients under local anesthesia in the outpatient clinic is a well-tolerated, safe, and effective procedure.

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“…But this was not the case for at least two reasons, namely the full closure of all non-COVID-related activities (as per national directions) and the currently very limited experience with delivering this type of proctologic surgery. Undoubtedly, this should prompt health authorities and specialists to redesign and optimize the whole proctologic pathway across the national territory [21,22].…”

Section: Discussionmentioning

confidence: 99%

Deadlock of proctologic practice in Italy during COVID-19 pandemic: a national report from ProctoLock2020

et al. 2020

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Proctology is one of the surgical specialties that suffered the most during COVID-19 pandemic. Using data from a crosssectional worldwide web survey, we aimed to snapshot the current status of proctologic practice in Italy with differences between three macro areas (North, Centre, South). Specialists affiliated to renowned scientific societies with an interest in coloproctology were invited to join a 27-item survey. Predictive power of respondents' and hospitals' demographics on the change of status of surgical activities was calculated. The study was registered at ClinicalTrials.gov (NCT 04392245). Of 299 respondents from Italy, 94 (40%) practiced in the North, 60 (25%) in the Centrer and 82 (35%) in the South and Islands. The majority were men (79%), at consultant level (70%), with a mean age of 46.5 years, practicing in academic hospitals (39%), where a dedicated proctologist was readily available (68%). Southern respondents were more at risk of infection compared to those from the Center (OR, 3.30; 95%CI 1.46; 7.47, P = 0.004), as were males (OR, 2.64; 95%CI 1.09; 6.37, P = 0.031) and those who routinely tested patients prior to surgery (OR, 3.02; 95%CI 1.39; 6.53, P = 0.005). The likelihood of ongoing surgical practice was higher in the South (OR 1.36, 95%CI 0.75; 2.46, P = 0.304) and in centers that were not fully dedicated to COVID-19 care (OR 4.00, 95%CI 1.88; 8.50, P < 0.001). The results of this survey highlight important factors contributing to the deadlock of proctologic practice in Italy and may inform the development of future management strategies.

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Tailored anal block (TAB): a new anesthesia procedure for surgical treatment of hemorrhoids in an outpatient setting

Cited by 8 publications

References 3 publications

Local Perianal Anesthetic Infiltration Is Safe and Effective for Anorectal Surgery

Local Perianal Anesthetic Infiltration Is Safe and Effective for Anorectal Surgery

Open Hemorrhoidectomy With Ligasure™ Under Local or Spinal Anesthesia: A Comparative Study

Deadlock of proctologic practice in Italy during COVID-19 pandemic: a national report from ProctoLock2020

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