The comparison of effect of spinal and caudal anesthesia at perianal surgery

The aim of this study was to compare the additional effect of fentanyl to caudal epidural and spinal block with low dose levobupicaine in outpatient perianal surgery.After local ethics committee and patient approval, fourty patients, aged 18-65 years old, ASA I-II group were allocated to one of two groups. Patients with spinal or caudal anesthesia contraindication were excluded from the study. Patients in caudal anesthesia group (Group K) received caudal epidural anesthesia with 0,25ml/kg %0,5 levobupivacaine+25µg fentanyl in prone position. The patients in group spinal anesthesia ( Group S) was given 2,5 ml %0,5 levobupivacaine +8 ?g fentanyl to intrathecal space.After monitorisation of patients their ECG and noninvasive blood pressure values were recorded. After caudal and spinal block, 5. , 10. , 15. , 30. minutes, and at the end of operation and postoperatively 15. minutes, mean blood pressure, hearth rate, motor block levels, sensation block levels, VAS skores and operation times were recorded. The first analgesic required time was recorded and when VAS ? 5; patients received tramadol 50 mg iv. Total amount of analgesic dose was recorded at the end of twenty four hours. We evaluated intraoperative surgeon and patient satisfaction as 4: Perfect, 3: Good, 2: Medium, 1: Bad.There were no differences between groups about mean blood pressure and heart rate. We observed no motor block and faster mobilization and anesthetic recovery in Group K. The time of first analgesic requirement was longer in this group. In both groups regional anaesthesia level was adequate and statistically were no difference between surgery comfort and patient satisfaction.As a result, elective outpatient perianal surgery adequate anesthesia and analgesia was managed with the spinal and epidural anesthesia by adding fentanyl to low dose of levobupivacaine. Caudal epidural block with using low-dose levobupivacaine provided longer duration without any motor block with an advantage of early mobilization.