Cañas EEG, Aguilar MF, Llanes DG

Language: Spanish
References: 0
Page: 70-78
PDF size: 75.74 Kb.

ABSTRACT

The usefulness and the safety of a regional anesthesic block protocol in the management of benign anorectal diseases are presented in this article. Ninety six patients were recruited at the Services of Coloproctology, “Hermanos Ameijeiras” and “Calixto García” hospitals (both located in Havana City), between February-October, 2004. Hemorrhoids (46.8%) and anal fissures (24.5%) were prevalent in the study serie. Two groups were formed: Group A (48 patients): “Saddle-block” anesthesia, according with the practice of the Service of Anesthesia; and Group B (48 patients): regional anesthesic block, as described previously. Patients were monitored at 2, 6, 12 and 24 hours after completed the surgical procedure. The operational characteristics of the regional anesthesic block protocol were estimated from the transoperatory control of pain, the post-operatory control of pain, the use of analgesics, and the occurrence of post-surgical complications. Neither of the protocols outperformed the other in the management of the transoperatory pain: it was not necessary to use another anesthesic for concluding the procedure. A better management of the post-operatory pain was observed with the regional anesthesic block protocol: 64.6% of Group B patients referred to be asymptomatic 12 hours after the surgical procedure, in contrast with only 6.3% of Group A patients (p ‹ 0.05). The use of NSAID’s for post-operatory pain management was similar in both groups. It is to be noticed that 87.5% of Group A used intramuscular Dipirone for pain management, in contrast with only 33.3% of Group B. The average intramuscular Dipirone doses were similar in both patients groups. There was a 36.5% global complication rate. Groups differed regarding the type of complication. Urinary retention (35.4%) and pain at the site of lumbar punction (25.0%) were more frequent among Group A. On the other hand, pain at the site of anesthesia (12.5%) and posterior perianal hematoma (8.3%) were prevalent among Group B. From the results of this study it can be concluded that, although both anesthesia protocols were similar regarding perioperatory pain management, regional anesthesic block protocol allowed a better management of pain during the 6-12 hours time lapse after surgery, and it was associated with a lower use of intramuscular analgesics, and less complex post-operatory complications, and thus, more easy to manage and treat.