Efficacy of perianal nerve blockfor day care ano-rectal procedures

Abstract
Aim of this study was to assess patient safety, comfort, satisfaction level and quality of anaesthesia in patients undergoing day care ano-rectal procedures performed under Perianal Nerve Block (PNB) in comparison with Spinal Anaesthesia (SA) in peripheral medicare settings. MATERIAL AND METHODS: The study was a prospective, single centre study performed over a period of two years on 65 patients scheduled for various day care ano-rectal procedures. The patients were randomized to receive PNB or SA. The PNB was established using a mixture of 20ml of 2% lignocaine Hydrochloride (plain) and 20ml of 0.5% Bupivacaine Hydrochloride (plain) by four point perianal injection with Perianal subcutaneous infiltration augmentation technique whereas in all SA patients, the spinal block was established using 2 ml of 0.5% Bupivacaine (heavy) using 25G spinal needle in sitting position. All patients received premedication in the form of Inj Glycopyrrolate 0.2mg/iv and Inj Ondansetrone 8mg/iv. Patients were thereafter evaluated for pain and discomfort during the establishment of anesthesia, per-operatively and postoperatively for three days using a 10 point Visual Analogue Scale (VAS) and patient satisfaction level (1-5 point score). RESULTS: A total population of 65 patients out of 90 was found eligible for the study and were divided into two groups to either receive spinal anaesthesia (SA group, n=33) or Perianal nerve block (PNB group, n=32). Mean VAS during establishment of nerve block was 3.625 in PNB group and 1.2424 in SA group. Intra-operatively, VAS score was not very significantly variable in both the study groups. Mean VAS for post-operative pain during initial 12 hrs was 2.437 in PNB group and 5.878 in SA group.(P