title: Perirectal block for out-patient anorectal surgery: a new technique.
abstract: BACKGROUND
  Perirectal block using four puncture places has been classically described for rectal surgery.
  
  
  OBJECTIVE
  This paper was aimed at showing the quality of anesthesia and postoperative analgesia using a new two-puncture-site technique.
  
  
  METHODS
  Patients scheduled for ambulatory rectal surgery between January/2003 and December/2007 were included consecutively. The new two-puncture technique was used. Alternative anesthetic management and level of postoperative pain requirements were evaluated (rated visual analogue scale-VAS). Follow-up was done by telephone between 1st and 10th postoperative day to evaluate complications, pain (yes/no), and satisfaction level (1-5 points score).
  
  
  RESULTS
  Four hundred and nine subjects were included; 50.61% were female. Mean age was 43 (95%CI: 41-44; range: 17-85), 12.7% were aged over 60. According to the American Society of Anesthesiology (ASA), 72.6% were classified as ASA1 and 26.1% ASA2. External and internal hemorrhoidectomy was performed on 31% of patients; 61.6% had two or more procedures. Lidocaine was used on 406 subjects. Ropivacaine was added for 9.2% of them and levobupivacaine for 89.4%. 394 patients were followed-up. Median follow-up was 4 days. A response was obtained from 346 subjects (84.6%); 105 (30.3%) recalled having suffered pain during the post-operative period, being most frequent in the lidocaine+ropivacaine group (17/39, 43.5%) than in the lidocaine+bupivacaine group (88/307, 28.6%). Satisfaction was evaluated by 336 subjects (82.1%), 332 of them (98.8%) awarding a score of 5. Two subjects (0.6%) scored this 2 and 1. Subjects did not mention complications.
  
  
  CONCLUSIONS
  The new peri-rectal two-puncture block technique is easy and also provides analgesia and a high degree of satisfaction.
authors.affiliation: Departamento de Anestesiología, Clínicas Colsánitas, Bogotá, D.C, Colombia.
authors.forename: Germán A
authors.initials: GA
authors.lastname: Díaz-Palacios
authors.forename: Javier H
authors.initials: JH
authors.lastname: Eslava-Schmalbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010045:Outpatients; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D012007:Rectum / Q000294:innervation* / Q000601:surgery*; D000077212:Ropivacaine; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008012:Lidocaine; D002045:Bupivacaine