Discharge Conditions of Spinal Anesthesia With Heavy Prilocaine-Fentanyl and Heavy Bupivacaine-Fentanyl
Condition: Hemorrhoid; Peri Anal Fistula
MeSH terms: Hemorrhoids; Rectal Fistula; Fistula
Study type: Interventional
Phase: Phase 4

Summary: 
      In this prospective randomized study the investigators aimed to investigate difference of the
      duration of spinal anesthesia, discharge times and efficacy between low dose heavy
      Prilocaine-Fentanyl and heavy Bupivacaine-Fentanyl in outpatient minor anal surgery.
    

Detailed description: 
      ASA status I-III patients will be recruited. Patients will be randomized in two groups. Group
      B will be received 1.5 ml heavy bupivacaine+ 20 mic fentanyl+ 0.15 ml and Group P will be
      received 1,5 ml heavy prilocaine+20 mic fentanyl in the same volume.Patients will be
      monitored with electrocardiography, peripheral oxygen saturation(sPO2) and non invasive blood
      pressure (Drager Infinity Delta; 16 Electronics Avenue, Danvers, MA 01923 USA). After
      inserting a 20 G intravenous line the patients will be hydrated with 10 ml/kg 0.9 % saline.

      Preoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood
      pressure (MBP), heart rate (HR) and Spo2 will be measured and recorded.

      Spinal anesthesia will be commenced in the sitting position with a 25 G Quincke needle, with
      the midline approach. After observing free flow of cerebrospinal fluid the prepared study
      drug will be injected in 15 seconds. The patients will be placed supine after waiting 2
      minute in the sitting position. Supplemental oxygen via nasal cannula will be provided.

      Fentanyl and midazolam will be used for rescue analgesia and sedation and recorded.

      Sensorial block will be assessed with pinprick test with 2 minute intervals until the maximum
      block achieves and with 15 minute intervals until the block was regresses to S3 dermatome.
      Motor block will be assessed with the Bromage score when the block reached the maximum level.
      Patients will be transferred to postoperative care unit (PACU) at he end of surgery.

      Pain will be assessed on a 10 point visual analog scale (VAS)(0= no pain, 10= worst pain
      ever). Postoperative analgesia will be provided with 2 mg.kg-1 tramadol or 15 mg.kg-1
      paracetamol when the VAS score is ≥3 time of first analgesic request will be recorded.

      Hypotension (≥20% reduced from baseline values) will be treated with ephedrine or iv fluid
      boluses), bradycardia (HR<45 beat min-1 was treated with atropine) was recorded.

      The patients will be asked whether to void before surgery. Bladder volume will be assessed
      with ultrasonography. Patients with residual bladder volumes ≥400 ml will be placed an urine
      catheter. Time to first urinate will be recorded.

      Patients will be assessed for transient neurologic symptoms(pain in the buttocks and
      legs)(TNS) and satisfaction after surgery.

      TNS will be evaluated with daily telephone calls. Patient satisfaction will be evaluated with
      global satisfaction scale (1= bad, 2=not satisfied, 3=have no idea, 4=satisfied, 5=very
      satisfied) Parameters to record; time of entering operation room, duration of surgery, time
      of intrathecal injection, onset of sensorial block(block at L1), time to reach maximum block
      level, maximum block level, first analgesic ingestion time, PACU duration, two segment
      regression, time to L1 regression, time to S3 regression, time to it without help, time to
      stand up without help, time to walk without help, discharge time, time to first void. TNS,
      patient satisfaction score.
    

Intervention name(s): Prilocaine; Bupivacaine
Intervention type(s): Drug; Drug
Intervention description(s): experimental; marcaine heavy 0.5% 7.5 mg intrathecal
Other intervention name(s): prilothecal; citanest; marcaine heavy 0.5%
Intervention MeSH terms: Bupivacaine; Prilocaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)