Local anesthetic infiltration versus caudal epidural block for anorectal surgery: a randomized controlled trial

Study ObjectiveTo compare patient satisfaction with local anesthetic infiltration versus caudal epidural block for anorectal procedures.DesignRandomized controlled trial.SettingOperating room and postanesthesia care unit (PACU).Patients22 adult, ASA physical status I, II, and III patients scheduled for anorectal surgery.InterventionsPatients were randomized to receive either local anesthetic infiltration (LAI) (n = 10) by the surgeon or caudal epidural block (CEB) (n = 12) by the anesthesiologist.MeasurementsThe primary outcome was patient satisfaction with the anesthetic technique and pain relief 12 hours after the procedure on a 4-point Likert scale. Secondary outcomes included time to first analgesic request, time to reach a PACU discharge score (REACT score) of 10, time to ambulation, time to discharge home, and adverse events.Main ResultsMore subjects in the CEB group (83.3%) were highly satisfied than in the LAI group (20%; P = 0.003), assessed 12 hours postoperatively by telephone interview. Subjects in the CEB group requested analgesia 423 minutes later (95% confidence interval, 286-560 min) than subjects in the LAI group. Differences in time to reach a REACT score of 10, time to ambulation, and time to discharge home were not statistically significant.ConclusionsCaudal epidural block provides higher patient satisfaction and longer lasting analgesia than LAI without delaying discharge.