Hyperbaric levobupivacaine in anal surgery : Spinal perianal and spinal saddle blocks

An ideal anesthetic technique for anal surgery on an outpatient basis should permit early mobilization without pain or residual complications of anesthesia. The aim of this study was to analyze the reliability and efficacy of spinal perianal and spinal saddle block by using two different doses of levobupivacaine for perianal surgery and their effects on voiding, first analgesic requirement and hospital discharge times.

A prospective, randomized, double-blinded study was conducted on 78 ASA I-II patients scheduled for elective perianal surgery. Patients were randomized into two groups, the spinal perianal group and the spinal saddle group. Hyperbaric levobupivacaine 1.5 mg (perianal) or 6 mg (saddle) was administered intrathecally through the L4-5 intervertebral space by a 25-gauge Whitacre spinal needle with the patient in the sitting position. Sensory block was evaluated using a surgical toothless clamp until satisfactory block reached the S4 sensory level and motor block was evaluated using a modified Bromage scale. Patient and surgeon satisfaction were recorded for each patient. Ambulation, voiding and hospital discharge times were assessed.

There was no statistical difference between the two groups demographically. Perianal low dose levobupivacaine use resulted in no motor block (Bromage=0, p=0.006) and a sensory block limited to the S4 level. The low and conventional doses of levobupivacaine provided sufficient anesthesia during the surgical procedures. The sensory block regression time in the perianal block group was shorter than the saddle group (p=0.048). Time to first analgesic requirement was significantly longer in the saddle block group (p<0.05). The times of first ambulation, the first voiding and hospital discharge in patients with the perianal block were significantly shorter than patients in the saddle block (p<0.05, p<0.01, p<0.05, respectively).

The results of the study showed that the use of 1.5 mg hyperbaric levobupivacaine provides sufficient and satisfactory anesthesia in ambulatory perianal surgery.