Optimizing Care: Local Anesthesia as a Valuable Tool in the Treatment of Anal Diseases within the Community Healthcare Sphere
Keywords:
Local Anesthesia, Treatment, Anal, Diseases, Healthcare, Quality of lifeAbstract
Information is provided: It is imperative to ensure adequate pain management in outpatient procedures pertaining to anorectal diseases, as this has a significant impact on patient satisfaction and the speed of recovery.
The objective of this study is to undertake a comparative analysis of infiltration anesthesia and nerve-block anesthesia techniques in the context of patient treatment for anorectal procedures.
Methodology: A prospective randomized controlled trial was conducted in a group of 190 patients diagnosed with anorectal diseases. Patients were then randomly assigned to receive either local anesthesia prior to the procedure. The pain levels experienced by the subjects before and after the procedure VAS were measured at three distinct points in time: during the procedure, immediately after, and 24 hours after the procedure. The statistical analyses performed included t-tests and analysis of variance (ANOVA), with the objective of examining the differences in pain scores between the two groups.
The results of the study are as follows: Patients receiving Group 2 got neuraxial anesthesia reported significantly lower pain scores during the procedure and higher levels of satisfaction in the nerve block group (85% vs. 60%, P < 0.05). No significant complications were observed in either group. Conclusions: The authors conclude that nerve block anesthesia offers superior pain control in comparison to regional anesthesia during anorectal procedures and may consequently result in an enhancement in patient satisfaction and compliance with medical care in the future. Further research is required to investigate the long-term results and applicability of nerve block under various clinical conditions.
References
Li S, Coloma M, White PF, Watcha MF, Chiu JW, Li H, et al. Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery. Anesthesiology. (2000) 93:1225–30. 10.1097/00000542-200011000-00015 [DOI] [PubMed] [Google Scholar]
Imbelloni LE, Vieira EM, Gouveia MA, Netinho JG, Spirandelli LD, Cordeiro JA. Pudendal block with bupivacaine for postoperative pain relief. Dis Colon Rectum. (2007) 50:1656–61. 10.1007/s10350-007-0216-7 [DOI] [PubMed] [Google Scholar]
Lohsiriwat V, Lohsiriwat D. Ambulatory anorectal surgery under perianal anesthetics infiltration: analysis of 222 cases. J Med Assoc Thai. (2007) 90:278–81. [PubMed] [Google Scholar]
Argov S, Levandovsky O, Yarhi D. Milligan-Morgan hemorrhoidectomy under local anesthesia - an old operation that stood the test of time: a single-team experience with 2,280 operations. Int J Colorectal Dis. (2012) 27:981–5. 10.1007/s00384-012-1426-6 [DOI] [PubMed] [Google Scholar]
Arroyo A, Pérez F, Serrano P, Candela F, Calpena R. Open versus closed lateral sphincterotomy performed as an outpatient procedure under local anesthesia for chronic anal fissure: a prospective randomized study of clinical and manometric long-term results. J Am Coll Surg. (2004) 199:361–7. 10.1016/j.jamcollsurg.2004.04.016 [DOI] [PubMed] [Google Scholar]
Kushwaha R, Hutchings W, Davies C, Rao NG. Randomized clinical trial comparing day-care open haemorrhoidectomy under local versus general anaesthesia. Br J Surg. (2008) 95:555–63. 10.1002/bjs.6113 [DOI] [PubMed] [Google Scholar]
Gold B S, Young ML, Kinman J L, Kitz D S, Berlin J, Schwartz J S. The utility of preoperative electrocardiograms in the ambulatory surgical patient. Arch Intern Med. 1992;152 (2):301–305. [PubMed] [Google Scholar]
Apfelbaum J L, Connis R T, Nickinovich D G. et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116 (3):522–538. doi: 10.1097/ALN.0b013e31823c1067. [DOI] [PubMed] [Google Scholar]
Joshi G P, Ankichetty S P, Gan T J, Chung F. Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. Anesth Analg. 2012;115 (5):1060–1068. doi: 10.1213/ANE.0b013e318269cfd7. [DOI] [PubMed] [Google Scholar]
Friedman Z Chung F Wong D T; Canadian Anesthesiologists' Society. Ambulatory surgery adult patient selection criteria - a survey of Canadian anesthesiologists Can J Anaesth 2004515437–443. [DOI] [PubMed] [Google Scholar]
Coloma M, Duffy L L, White P F, Kendall Tongier W, Huber P J Jr. Dexamethasone facilitates discharge after outpatient anorectal surgery. Anesth Analg. 2001;92 (1):85–88. doi: 10.1097/00000539-200101000-00017. [DOI] [PubMed] [Google Scholar]
Wu J I, Lu S F, Chia Y Y, Yang L C, Fong WP, Tan P H. Sevoflurane with or without antiemetic prophylaxis of dexamethasone in spontaneously breathing patients undergoing outpatient anorectal surgery. J Clin Anesth. 2009;21 (7):469–473. doi: 10.1016/j.jclinane.2008.11.007. [DOI] [PubMed] [Google Scholar]
Page MJ, McKenzie JE, Bossuyt PM, et al. (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71 [DOI] [PMC free article] [PubMed] [Google Scholar]
The R Foundation (2021) A language and environment for statistical computing. Free Software Foundation. https://www.R-project.org. Accessed 26 Feb 2023
Balduzzi SRG (2019) Schwarzer G How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health 22:153–160 [DOI] [PMC free article] [PubMed] [Google Scholar]
Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range, and/or interquartile range. BMC Med Res Methodol 14:135 [DOI] [PMC free article] [PubMed] [Google Scholar]
Myles PS, Myles DB, Galagher W, et al. (2017) Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 118 (3):424–429 [DOI] [PubMed] [Google Scholar]
Sterne JAC, Savovic J, Page MJ, et al. (2019) Rob 2: a revised tool for assessing the risk of bias in randomised trials. BMJ 366:l4898 [DOI] [PubMed] [Google Scholar]
Deeks JJ, Higgins JPT, Altman DG (2022) Chapter 10: analysing data and undertaking meta-analyses. Cochrane Library. https://training.cochrane.org/handbook/current/chapter-10. Accessed 26 Feb 2023
Balshem H, Helfand M, Schunemann HJ et al. (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64 (4):401–6 [DOI] [PubMed] [Google Scholar]
