Lateral Internal Sphincterotomy under Local and Spinal Anesthesia for Chronic Anal Fissure A Comparative Study
Trauma Monthly: 11 (1); 107-111 Article Type: Research Article
M. Lateral Internal Sphincterotomy under Local and Spinal Anesthesia for Chronic Anal Fissure A Comparative Study,
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In this study we evaluated the effectively of local anesthesia versus spinal anesthesia, for the internal Sphincterotomy . Objective: Material and Methods: In a randomized clinical trial, 62 patients with chronic anal fissure allocated in local anesthesia and spinal anesthesia groups. Patients informed about benefits and risks of each technique, and an informed consent obtained from patients who were agree to participate in the study. Injection site pain, intra-operative pain, pain 24 hour after operation, pain during the first defecation, and one week after operations were assessed by visual analog scale (VAS). Post-operative nausea, vomiting, headache, urinary retention and amount of analgesics administered, assessed in both groups. Statistical analyses were made by SPSS package, using chi-square, Fischer and T-tests. P-values less than 0.05 considered significant. Results : The average score of injection site pain in spinal anesthesia group was 1.61 and in local anesthesia group was 2.92 (p=0.012). Intra-operative pain and pain 1 hour following operation were not statistically different between two groups (P<0.05). The pain 6 hours and 24 hr post operation and also during first post-operative defection were respectively 3.77,1.65 and 4.29 vs. 1.9, 0.9 and 2.94 in spinal anesthesia group (P< 0.05). The amount of intravenous opioid analgesics in local anesthesia group was lower than spinal anesthesia group (p< 0.05). Occurrence of urinary retention and headache were greater in spinal anesthesia group (respectively, 19.4% and 25.8% vs. 0% and 3.2% with significant p-value). No major complication was seen in both studied groups. Conclusion: Spinal and local anesthesia are both safe for Sphincterotomy, but local anesthesia has less complications, such as headache and urinary retention, has less post-operative pain, and patients can be discharged earlier.
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