Comparison of Caudal Block and Saddle Block on Anorectal Surgery
Description:
Anorectal surgery includes pilonidal sinus, hemorrhoidectomy, anal fissure, and anal fistula
operations. Various surgical and anesthetic techniques have been used to increase the level
of patients perioperative analgesia and decrease the length of stay in the hospital.
Spinal Saddle block anesthesia applications are performed while the patient is in the sitting
position. Local anesthetic is given into the intrathecal space and it is aimed to localize
the applied agent around the hip and anorectal region with the effect of gravity. Thus,
sufficient level of anesthesia required during perianal region surgery and stable patient
hemodynamics is provided. Caudal block is widely used in both adults and pediatric patients
for intraoperative anesthesia and chronic pain management. Sacral hyperattenuation is
performed to reach the epidural space, a local anesthetic agent is given to the epidural
space, it is accepted as an easy and safe method and therefore it is frequently used in
anorectal surgeons.
In this study, investigators investigate the effects of routinely applied anesthesia
techniques during anorectal surgery, caudal block and saddle block, on patients’
perioperative hemodynamic values, sensory and motor block levels, and postoperative pain
scores. Elective anorectal surgery planned 100 patients between the 18-60 ages. The risk of
anesthesia in patients will be determined by ASA (American Society Of anesthesiologists),
ASA1 or ASA 2 risk group will be included after informed consents are approved.
Patient electrocardiogram (ECG), peripheral oxygen saturation (SpO2), non-invasive blood
pressure monitor will be performed in the operation room. Baseline hemodynamic-vital
parameters of the patients will be recorded. Patients undergoing caudal and saddle blocks,
will be compared as two randomized groups.
In the saddle block group hyperbaric bupivacaine at a dose of 7 mg will be given to the
intrathecal space after a 25 G quincke spinal needle is inserted with ultrasonography
guidance between L4-L5 vertebral disc and clear cerebrospinal fluid is seen. The patient will
be placed in sitting position for 5 minutes.
For the caudal block, sacral horns are palpated and sacral hiatus and epidural area will be
determined at S4-S5 level through ultrasonography. The 20 G adult caudal needle will then be
placed to the caudal epidural space and 25 mL bupivacaine at a concentration of 0.5% will be
applied in the prone Jack-Knife position with resistance loss. Sensory and motor block level,
heart rate (HR), systolic arterial pressure (SAB), diastolic arterial pressure (DAB), mean
arterial pressure (OAB) and SpO2 levels will be measured every 5 minutes until the end of the
operation. Sensory block level will be evaluated with "pinprick" test. Motor block level will
be evaluated by using Modified Bromage Scale (0 = no paralysis, thigh, leg and foot can be
removed, 1 = unable to move the thigh, move the knee,2 = cannot move the knee, can move the
ankle, 3 = cannot move the lower extremities at all) Once sensory block level is reached to
the L3 level the surgical procedure will begin.
Condition:
Anorectal Disorder
Treatment:
caudal block
Start Date:
June 20, 2018
Sponsor:
Kocaeli Derince Education and Research Hospital
For More Information:
https://clinicaltrials.gov/show/NCT03498547