항문 주위 수술을 위한 척추 안장마취 시 좌위 유지시간을 1분으로 하는 방법의 임상적 유용성에 대한 연구

Abstract

Background: Conventional spinal saddle block is performed in sitting position, keeping patient sitting between 3 to 10 min after injection of drug. This time, however, is long enough to cause prolonged urinary retention postoperatively. The trend in this block is lowering the dose of local anesthetics, providing selective segmental block, but an optimal dose and method are needed for adequate anesthesia in variable situations. So, in this study, we evaluated whether only 1 min sitting after the drug injection could be sufficient and safe for minor anorectal surgery. Methods: Two hundred and sixteen patients undergoing minor anorectal surgery under spinal anesthesia remained sitting for 1 min after completion of the subarachnoid administration of 1 ml of a 0.5% hyperbaric bupivacaine solution (5 mg). And then, they were placed in the jack-knife position. After surgery, analgesia levels were assessed using loss of cold sensation in the supine position. The next day urination and 11 point numeric rating scale (NRS) were assessed. Results: During surgical manipulation, there were no patients who needed additional analgesics. Postoperative sensory levels were T10[T8-T12] in patients. There were no significant differences between men and women (P = 0.857); height (P = 0.065); obesity (P = 0.873) and age (P = 0.138). Urinary retention developed in 7 patients (3.2%). In this group, NRS were 5.0 ± 2.4 (P = 0.014). Conclusions: One minute sitting position for spinal saddle block before jack-knife position can be useful for minor anorectal surgery and reduce the postoperative urinary retention development.