HOOK-NEEDLE PUNCTURE - A NEW TECHNIQUE OF LOCAL-ANESTHESIA FOR ANORECTAL SURGERY

PURPOSE: Anorectal surgery has been increasingly performed as an ambul atory procedure using general, regional, and local anesthesia. Local a nesthesia is classically performed through infiltration of four quadra nts around the anal verge, which renders the procedure painful and unc omfortable for most surgeons and patients. We present a new, painless technique of local anesthesia for anorectal surgery. METHODS: Patients with surgical risk Classes I and II (American Society of Anesthesiolo gists) bearing anorectal pathologies were sedated and placed on the op erating table in the prone jackknife position. After local antisepsis, the anal canal was lubricated with 2 percent lidocaine gel, and the m ucosa was punctured by a hook-shaped, curved, 22-gange needle just abo ve the pectinate line. A solution of local anesthetics was slowly infu sed in all four quadrants to the submucosal level. If needed, more ane sthetics were infused during the operation. RESULTS: This technique wa s easily and painlessly applied in more than 60 patients and permitted execution of several ambulatory anorectal procedures with comfort and safety. CONCLUSIONS: The hook-needle puncture for local anesthesia is an effective and safe procedure and may be routinely used for ambulat ory anorectal surgery in selected patients.