LOCAL-ANESTHESIA IS SUPERIOR TO SPINAL-ANESTHESIA FOR ANORECTAL SURGICAL-PROCEDURES

In this prospective study we compared local with spinal anesthesia for anorectal surgical procedures with regard to pain control, recovery t ime before unassisted ambulation, incidence of postoperative complicat ions, length of hospital stay, and cost effectiveness in 80 consecutiv e patients. Patients were allocated in two groups: group 1 (n = 52) re ceived local anesthesia, and group 2 (n = 28) had spinal anesthesia. T here were no intraoperative complications related to the anesthetic te chnique, and there was no difference between groups in the number of d oses of narcotics required to control postoperative pain (1.2 +/- 1.5 vs 1.8 +/- 1.7 in group 1 and 2 respectively, P > 0.05). Recovery time before unassisted ambulation was significantly longer in group 2 (139 +/- 96 minutes in group 2 vs 82 +/- 62 minutes in group 1, P < 0.05). There were 21/52 complications in group 1 in contrast to 21/28 in gro up 2, (P < 0.05). There was no difference between groups in the postop erative incidence of nausea, vomiting, headache, weakness, and constip ation; however, the incidence of postoperative urinary retention was s ignificantly higher in group 2 (5/52 in group 1 vs 9/28 in group 2, P < 0.05). As a result of urinary retention, more patients in group 2 re quired overnight hospitalization (12/52 in group 1 vs 21/28 in group 2 , P < 0.05). Patients in group 2 required 36 hospital days in contrast to 21 days for patients in group 1, P < 0.05. The difference in hospi tal days resulted in $18,000 greater cost for patients in group 2. Bas ed on the results of this study, we conclude that local anesthesia is superior to spinal anesthesia for anorectal surgical procedures.