Ultrasound-Guided Caudal Epidural Block Versus Saddle Block for Anorectal Surgeries: A Prospective Randomized...

Area of Science:

• Anesthesiology
• Surgical Procedures
• Regional Anesthesia

Background:

• Ambulatory anorectal surgeries require effective perineal anesthesia and rapid recovery for same-day discharge.
• Saddle block provides sacral anesthesia but can cause hypotension and urinary retention.
• Ultrasound-guided caudal epidural block (USG-CEB) is a potential alternative with selective blockade.

Purpose of the Study:

• To compare the efficacy and recovery profiles of USG-CEB versus saddle block in adult anorectal surgery.
• Primary outcomes: time to mobilization and time to first rescue analgesia.
• Secondary outcomes: sensory onset, hemodynamics, voiding time, and patient satisfaction.

Main Methods:

• Prospective randomized controlled study of 59 adult patients undergoing elective anorectal surgery.
• Patients randomized to USG-CEB or saddle block.
• Ultrasound guidance used for USG-CEB; rescue analgesia with tramadol; assessments by blinded observers.

Main Results:

• USG-CEB group showed significantly earlier mobilization (p<0.001) and voiding (p<0.001).
• Time to first rescue analgesia was longer in the USG-CEB group (p=0.021).
• Saddle block had faster sensory onset (p<0.001), but USG-CEB demonstrated more stable hemodynamics.

Conclusions:

• USG-CEB is an effective alternative for anorectal surgery, improving mobilization and voiding.
• USG-CEB offers hemodynamic stability but has a slower anesthetic onset.
• Anesthetic choice should be individualized, balancing recovery benefits against onset speed and analgesia needs.