Anesthésie locale et locorégionale pour la chirurgie proctologique

The techniques of local and regional anaesthesia are well-adapted to proctologic surgery; the related risk: benefit ratio is encouraging and patients report great satisfaction regarding the postoperative effect on pain. Safety as regards administration of local anaesthetics (LA) imposes the knowledge of their side effects, particularly the toxic effects, and a strict respect of the operating procedures, whatever the technique. The use of needles with short bevel is recommended. The LA amounts will have to be adapted to patient's weight in order to avoid accumulated doses close to the toxic amounts (multiple injections, or anaesthetic procedure on several sites). The technique of the pudendal block is based on an access of the nerve at the end of Alcock's canal. It may be performed an isolated infiltration of the pudendal nerve or a block of this nerve by neurostimulation. Its effectiveness can be improved by a multisite infiltration, as in the posterior perineal block.