Anesthesia for Anorectal Surgery

Abstract

Abstract Anorectal surgeries are common procedures that are typically performed as ambulatory surgery. The success of ambulatory surgery depends largely on a safe and efficient anesthetic technique. Well-placed local anesthesia in the anal canal with sedation can be cost-effective and can improve efficiency. Modification of the spinal anesthesia dose and techniques can provide suitable surgical anesthesia and postoperative analgesia. Modifications include spinal anesthesia with low-dose local anesthetics, saddle-block technique, and posterior hypobaric anesthesia. Transient neurologic syndrome can develop after spinal anesthesia with short-acting local anesthetics; however, with some modifications, the syndrome can be largely avoidable. Postoperative pain after anorectal surgery is very intense, especially at the onset of the first postoperative defecation. Caudal block provides the added benefit of prolonged postoperative analgesia. Bilateral pudendal nerve block provides excellent analgesia without urinary retention. Local infiltration using liposomal bupivacaine after anorectal surgery is effective and safe, and provides prolonged analgesia with opioid-sparing effects. The optimal anesthetic technique would provide excellent operating conditions, a rapid recovery, no postoperative side effects, and high patient satisfaction.