Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery

Background: Given the current practice environment, it is Important to dete rmine the anesthetic technique with the high est patient acceptance and low est associated costs. The authors compared three commonly used anesthetic t echniques for anorectal procedures in the ambulatory setting. Methods: Ninety-three consenting adult outpatients undergoing anorectal sur gery were randomly assigned to one of three anesthetic treatment groups: gr oup 1 received local infiltration with a 30-ml mixture containing 15 mi lid ocaine, 2%, and 15 mi bupivacaine, 0.5%, with epinephrine (1:200,000) in co mbination with intravenous sedation using a propofol infusion, 25-100 mug . kg(-1) . min(-1); group 2 received a spinal subarachnoid block with a comb ination of 30 mg lidocaine and 20 mug fentanyl with midazolam, 1-2-mg intra venous bolus doses; and group 3 received general anesthesia with 2.5 mg/kg propofol administered intravenously and 0.5-2% sevoflurane in combination w ith 65% nitrous oxide. In groups 2 and 3, the surgeon also administered 10 mi of the previously described local anesthetic mixture at the surgical sit e before the skin incision. Results: The mean costs were significantly decreased in group 1 ($69 +/- 20 compared with $104 +/- 18 and $145 +/- 25 in groups 2 and 3, respectively) because both intraoperative and recovery costs were lowest (P < 0.05), Alt hough the surgical time did not differ among the three groups, the anesthes ia time and times to oral intake and home-readiness were significantly shor ter in group 1 (vs, groups 2 and 3), There was no significant difference am ong the three groups with respect to the postoperative side effects or unan ticipated hospitalizations. However, the need for pain medication was less in groups 1 and 2 (19% and 19%, vs. 45% for group 3; P < 0.05), Patients in group 1 had no complaints of nausea (vs. 3% and 26% in groups 2 and 3, res pectively), More patients in group 1 (68%) were highly satisfied with the c are they received than in groups 2 (58%) and 3 (39%). Conclusions: The use of local anesthesia with sedation is the most cost-eff ective technique for anorectal surgery in the ambulatory setting.