title: Hook-needle puncture. A new technique of local anesthesia for anorectal surgery.
abstract: OBJECTIVE
  Anorectal surgery has been increasingly performed as an ambulatory procedure using general, regional, and local anesthesia. Local anesthesia is classically performed through infiltration of four quadrants around the anal verge, which renders the procedure painful and uncomfortable for most surgeons and patients. We present a new, painless technique of local anesthesia for anorectal surgery.
  
  
  METHODS
  Patients with surgical risk Classes I and II (American Society of Anesthesiologists) bearing anorectal pathologies were sedated and placed on the operating table in the prone jackknife position. After local antisepsis, the anal canal was lubricated with 2 percent lidocaine gel, and the mucosa was punctured by a hook-shaped, curved, 22-gauge needle just above the pectinate line. A solution of local anesthetics was slowly infused in all four quadrants to the submucosal level. If needed, more anesthetics were infused during the operation.
  
  
  RESULTS
  This technique was easily and painlessly applied in more than 60 patients and permitted execution of several ambulatory anorectal procedures with comfort and safety.
  
  
  CONCLUSIONS
  The hook-needle puncture for local anesthesia is an effective and safe procedure and may be routinely used for ambulatory anorectal surgery in selected patients.
authors.affiliation: Colorectal Unit, Hospital das Clínicas, University of São Paulo Medical School, Brazil.
authors.forename: C W
authors.initials: CW
authors.lastname: Sobrado
authors.forename: A
authors.initials: A
authors.lastname: Habr-Gama
mesh_terms: D000556:Ambulatory Surgical Procedures; D001003:Anal Canal / Q000601:surgery; D000772:Anesthesia, Local / Q000379:methods*; D006801:Humans; D012002:Rectal Diseases / Q000601:surgery*; D012007:Rectum / Q000601:surgery*