Local anesthetic infiltration versus caudal epidural block for anorectal surgery: a randomized controlled trial.
OBJECTIVE
To compare patient satisfaction with local anesthetic infiltration versus caudal epidural block for anorectal procedures.


METHODS
Randomized controlled trial.


METHODS
Operating room and postanesthesia care unit (PACU).


METHODS
22 adult, ASA physical status I, II, and III patients scheduled for anorectal surgery.


METHODS
Patients were randomized to receive either local anesthetic infiltration (LAI) (n = 10) by the surgeon or caudal epidural block (CEB) (n = 12) by the anesthesiologist.


METHODS
The primary outcome was patient satisfaction with the anesthetic technique and pain relief 12 hours after the procedure on a 4-point Likert scale. Secondary outcomes included time to first analgesic request, time to reach a PACU discharge score (REACT score) of 10, time to ambulation, time to discharge home, and adverse events.


RESULTS
More subjects in the CEB group (83.3%) were highly satisfied than in the LAI group (20%; P = 0.003), assessed 12 hours postoperatively by telephone interview. Subjects in the CEB group requested analgesia 423 minutes later (95% confidence interval, 286-560 min) than subjects in the LAI group. Differences in time to reach a REACT score of 10, time to ambulation, and time to discharge home were not statistically significant.


CONCLUSIONS
Caudal epidural block provides higher patient satisfaction and longer lasting analgesia than LAI without delaying discharge.
Siddiqui
Zafar I
ZI
Department of Anesthesia, Tufts-New England Medical Center and Tufts University School of Medicine, Box 298, Boston, MA 02111, USA.
Denman
William T
WT
Schumann
Roman
R
Hackford
Alan
A
Cepeda
M Soledad
MS
Carr
Daniel B
DB
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012007:Rectum / Q000601:surgery*
D000779:Anesthetics, Local