Caudal Block,Saddle Block, Anorectal Surgery
Condition: Anorectal Disorder
MeSH terms: Rectal Diseases
Study type: Interventional

Summary: 
      Anorectal surgery includes pilonidal sinus, hemorrhoidectomy, anal fissure, and anal fistula
      operations. Various surgical and anesthetic techniques have been used to increase the level
      of analgesia in perioperative period and decrease the length of stay in the hospital. In this
      study, investigators investigate the effects of routinely applied anesthesia techniques
      during anorectal surgery, caudal block and saddle block, on patients' perioperative
      hemodynamic values, sensory and motor block levels, and postoperative pain scores.
    

Detailed description: 
      Anorectal surgery includes pilonidal sinus, hemorrhoidectomy, anal fissure, and anal fistula
      operations. Various surgical and anesthetic techniques have been used to increase the level
      of patients perioperative analgesia and decrease the length of stay in the hospital.

      Spinal Saddle block anesthesia applications are performed while the patient is in the sitting
      position. Local anesthetic is given into the intrathecal space and it is aimed to localize
      the applied agent around the hip and anorectal region with the effect of gravity. Thus,
      sufficient level of anesthesia required during perianal region surgery and stable patient
      hemodynamics is provided. Caudal block is widely used in both adults and pediatric patients
      for intraoperative anesthesia and chronic pain management. Sacral hyperattenuation is
      performed to reach the epidural space, a local anesthetic agent is given to the epidural
      space, it is accepted as an easy and safe method and therefore it is frequently used in
      anorectal surgeons.

      In this study, investigators investigate the effects of routinely applied anesthesia
      techniques during anorectal surgery, caudal block and saddle block, on patients'
      perioperative hemodynamic values, sensory and motor block levels, and postoperative pain
      scores. Elective anorectal surgery planned 100 patients between the 18-60 ages. The risk of
      anesthesia in patients will be determined by ASA (American Society Of anesthesiologists),
      ASA1 or ASA 2 risk group will be included after informed consents are approved.

      Patient electrocardiogram (ECG), peripheral oxygen saturation (SpO2), non-invasive blood
      pressure monitor will be performed in the operation room. Baseline hemodynamic-vital
      parameters of the patients will be recorded. Patients undergoing caudal and saddle blocks,
      will be compared as two randomized groups.

      In the saddle block group hyperbaric bupivacaine at a dose of 7 mg will be given to the
      intrathecal space after a 25 G quincke spinal needle is inserted with ultrasonography
      guidance between L4-L5 vertebral disc and clear cerebrospinal fluid is seen. The patient will
      be placed in sitting position for 5 minutes.

      For the caudal block, sacral horns are palpated and sacral hiatus and epidural area will be
      determined at S4-S5 level through ultrasonography. The 20 G adult caudal needle will then be
      placed to the caudal epidural space and 25 mL bupivacaine at a concentration of 0.5% will be
      applied in the prone Jack-Knife position with resistance loss. Sensory and motor block level,
      heart rate (HR), systolic arterial pressure (SAB), diastolic arterial pressure (DAB), mean
      arterial pressure (OAB) and SpO2 levels will be measured every 5 minutes until the end of the
      operation. Sensory block level will be evaluated with "pinprick" test. Motor block level will
      be evaluated by using Modified Bromage Scale (0 = no paralysis, thigh, leg and foot can be
      removed, 1 = unable to move the thigh, move the knee,2 = cannot move the knee, can move the
      ankle, 3 = cannot move the lower extremities at all) Once sensory block level is reached to
      the L3 level the surgical procedure will begin.
    

Intervention name(s): caudal block; saddle block
Intervention type(s): Procedure; Procedure
Intervention description(s): For the caudal block, sacral horns are palpated and sacral hiatus and epidural area will be determined at S4-S5 level through ulştrasonography. The 20 G adult caudal needle will then be placed to the caudal epidural space and 25 mL bupivacaine at a concentration of 0.5% will be applied in the prone Jack-Knife position with resistance loss.; In the saddle block group hyperbaric bupivacaine at a dose of 7 mg will be given to the intrathecal space after a 25 G quincke spinal needle is inserted with ultrasonographyguidance between L4-L5 vertebral disc and clear cerebrospinal fluid is seen. The patient will be placed in sitting position for 5 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: caudal block; saddle block