title: Local anesthesia and midazolam versus spinal anesthesia in ambulatory pilonidal surgery.
abstract: OBJECTIVE
  To evaluate two anesthetic techniques, namely, local anesthesia with sedation, and spinal anesthesia, with respect to recovery times, postoperative side effects, pain scores, patient satisfaction, and hospital costs for ambulatory pilonidal disease surgery.
  
  
  METHODS
  Prospective, randomized study.
  
  
  METHODS
  University Hospital of Pamukkale.
  
  
  METHODS
  60 consenting patients scheduled for pilonidal disease operation with Limberg flap technique.
  
  
  METHODS
  Patients were randomly allocated into two groups: Group 1 (n = 30) received spinal anesthesia with hyperbaric bupivacaine 1.5 mL 0.5%, and Group 2 (n = 30) received local infiltration with a 50-mL mixture containing 10 mL bupivacaine 0.5%, 10 mL prilocaine HCl 2%, and 30 mL isotonic solution with 1:200,000 epinephrine in combination with intravenous (i.v.) midazolam sedation.
  
  
  METHODS
  Perioperative and postoperative side effects, patient satisfaction, preoperative visual analog scale (VAS) pain scores, and VAS scores from the fourth hour postoperatively until the seventh day were assessed. Anesthesia, operation, surgery, and total hospital time, and costs (drug, resources, and labor) were recorded.
  
  
  RESULTS
  No difference was found between groups in the frequency of side effects. Urinary retention was diagnosed in two patients in the spinal anesthesia group. There was no statistical significant difference seen in satisfaction scores between groups. No statistical significance in VAS pain scores between groups was noted except for the fourth postoperative hour values. The average time spent in the operating room (OR) was greater in the spinal anesthesia group. All Group 2 patients achieved fast-tracking criteria in the OR and were able to bypass the postanesthesia care unit (PACU). Total hospital time and total cost were significantly higher in the spinal anesthesia group than local anesthesia-sedation group (p < 0.05).
  
  
  CONCLUSIONS
  The use of local anesthesia-sedation for ambulatory anorectal surgery resulted in a shorter hospital time, lower hospital costs, and no side effects compared with spinal anesthesia.
authors.affiliation: Department of Anesthesiology, Pamukkale University School of Medicine, Denizli, Turkey. hsungurtekin@yaho.com
authors.forename: Hulya
authors.initials: H
authors.lastname: Sungurtekin
authors.forename: Ugur
authors.initials: U
authors.lastname: Sungurtekin
authors.forename: Ergun
authors.initials: E
authors.lastname: Erdem
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics; D000762:Anesthesia Recovery Period; D000772:Anesthesia, Local / Q000009:adverse effects / Q000191:economics; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000191:economics; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000191:economics; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000191:economics; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D017060:Patient Satisfaction; D010864:Pilonidal Sinus / Q000191:economics / Q000601:surgery*; D011446:Prospective Studies
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam