Zengin Emine N, Yalnız Kudret Y, Başkan Semih, Öztürk Levent
Anesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, TUR.
Cureus. 2023 Jun 27;15(6):e41063. doi: 10.7759/cureus.41063. eCollection 2023 Jun.
Saddle block anesthesia (SBA) is a frequently preferred method for ambulatory anorectal surgery. This study aimed to observe the effects of two different dose SBAs on discharge times and perioperative block characteristics in patients undergoing ambulatory anorectal surgery.
The study was conducted as a prospective, randomized controlled study. Patients over the age of 18 who were scheduled for ambulatory anorectal surgery and had American Society of Anaesthesiologists (ASA) physical status I and II were included in the research. Patients were divided into two groups: 5 mg hyperbaric bupivacaine 0.5% (Group I; n=34) and 3 mg hyperbaric bupivacaine 0.5% (Group II; n=34). The primary outcome was discharge time. Characteristics of the spinal block like time to reach S4 blockade, maximum blocked dermatome, regression time of sensorial, first analgesic need time, voiding time, mobilization time, and side effects were the secondary outcomes.
Sixty-eight patients were included in the study. The groups were similar in terms of demographic and surgical characteristics (p > 0.05). In Group II, S4 sensory dermatome blockade time was statistically longer (p: 0.007) and the time to the disappearance of the sensory block was statistically shorter (p < 0.001). Also, voiding time and discharge times were statistically shorter in Group II (p: 0.049, p < 0.001, respectively).
SBA provided adequate anesthesia, and the complication rates were limited. Saddle block can be considered an advantageous technique because of conditions that adversely affect recoveries, such as postoperative cognitive problems, nausea, and vomiting due to general anesthesia. In addition, better recovery results and optimal surgical condition with 3 mg hyperbaric bupivacaine in our study suggest that this dose may be a good alternative.
鞍区阻滞麻醉（SBA）是门诊肛肠手术中常用的麻醉方法。本研究旨在观察两种不同剂量的鞍区阻滞麻醉对门诊肛肠手术患者出院时间和围手术期阻滞特征的影响。
本研究为前瞻性随机对照研究。纳入年龄在18岁以上、计划行门诊肛肠手术且美国麻醉医师协会（ASA）身体状况为I级和II级的患者。患者分为两组：0.5%重比重布比卡因5mg组（I组；n = 34）和0.5%重比重布比卡因3mg组（II组；n = 34）。主要观察指标为出院时间。蛛网膜下腔阻滞的特征，如达到S4阻滞的时间、最大阻滞皮节、感觉恢复时间、首次镇痛需求时间、排尿时间、活动时间及副作用等为次要观察指标。
68例患者纳入本研究。两组在人口统计学和手术特征方面相似（p > 0.05）。II组中，S4感觉皮节阻滞时间在统计学上更长（p：0.007），感觉阻滞消失时间在统计学上更短（p < 0.001）。此外，II组的排尿时间和出院时间在统计学上更短（分别为p：0.049，p < 0.001）。
鞍区阻滞麻醉提供了充分麻醉，并发症发生率有限。由于全身麻醉会导致如术后认知问题、恶心和呕吐等不利于恢复的情况，鞍区阻滞可被视为一种有利的技术。此外，本研究中使用3mg重比重布比卡因可获得更好的恢复效果和最佳手术条件，提示该剂量可能是一个不错的选择。
