title: Impact of spinal versus general anesthesia on postoperative pain and long term recurrence after surgery for pilonidal disease.
abstract: OBJECTIVE
  To assess the effect of the kind of anesthesia on postoperative pain and long term recurrence rate in pilonidal sinus disease.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Surgical departments of German Armed Forces Hospitals in Hamburg, Bad Zwischenahn and Hamm.
  
  
  METHODS
  583 pilonidal sinus disease (PSD) surgery patients operated for pilonidal disease.
  
  
  METHODS
  Interview of randomly selected patients, who had been followed up to 20years after PSD surgery.
  
  
  METHODS
  Analysis of long term recurrence-free survival and postoperative pain scores among patients who received different anesthesia modalities.
  
  
  RESULTS
  Recurrence occurred in 21.97% of patients who received general anesthesia with intubation (ITN), in 23.32% of spinal anesthesia (SPA), and in 31.91% of local- or cryoanesthesia. Our data indicate that there was no significant difference in recurrence-free time between the types of anesthesia in any of the surgical procedures applied. Pain scores of patients who underwent primary midline closure (4.74±2.63, 95% CI [4.36, 5.12]) were significantly lower than pain scores of patients who underwent marsupialization (6.12±2.71, 95% CI [5.17, 7.07]) or primary open treatment (6.09±2.79, 95% CI [5.79, 6.39]) (P<.0001). Post-operative pain scores did not differ between patients who received ITN or SPA. Cryo- or local anesthesia resulted in significantly lower post-operative pain scores compared to ITN (P=.0089) or SPA (P=.0031).
  
  
  CONCLUSIONS
  The use of SPA or general anesthesia did not affect the long term recurrence rate in PSD. Postoperative pain experienced either in-hospital or after discharge did not differ between patients receiving ITN or SPA. With other cryo- or local anesthesia, postoperative pain score was significantly reduced in any surgical procedure. However, due to the higher recurrence rate after cryo- or local anesthesia, only SPA and general anesthesia should be applied. The decision whether spinal or general anesthesia is applied in PSD surgery remains a purely anesthesiological decision based on standard considerations.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Bern University Hospital Inselspital, University of Bern, Switzerland. Electronic address: markus.luedi2@insel.ch.
authors.forename: Markus M
authors.initials: MM
authors.lastname: Luedi
authors.affiliation: Zurich University of Applied Sciences ZHAW, Waedenswil, Zurich, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Kauf
authors.affiliation: Department of Surgery, Military Hospital Berlin, Academic teaching Hospital of the Charité, Berlin, Germany.
authors.forename: Theo
authors.initials: T
authors.lastname: Evers
authors.affiliation: Department of Surgery, Military Hospital Berlin, Academic teaching Hospital of the Charité, Berlin, Germany.
authors.forename: Heidi
authors.initials: H
authors.lastname: Sievert
authors.affiliation: Department of Surgery, Military Hospital Berlin, Academic teaching Hospital of the Charité, Berlin, Germany; Klinikum rechts der Isar, Department of Surgery, Technische Universität München, Munich, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Doll
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D000775:Anesthesia, Spinal; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010864:Pilonidal Sinus / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
keywords: General anesthesia; Postoperative pain; Quality of life; Spinal anesthesia; pilonidal sinus