Nerve block: perianal block: Difference between revisions
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==Overview== | ==Overview== | ||
* Perianal blocks have been shown to be comparable to general anesthesia for in terms of pain control in anal procedures including surgeries <ref>Gerjy, R. et al. Randomized clinical trial of stapled haemorrhoidopexy performed under local perianal block versus general anaesthesia. Br J Surgy. 2008; 95(11):1344-51.</ref> | *Perianal blocks have been shown to be comparable to general anesthesia for in terms of pain control in anal procedures including surgeries <ref>Gerjy, R. et al. Randomized clinical trial of stapled haemorrhoidopexy performed under local perianal block versus general anaesthesia. Br J Surgy. 2008; 95(11):1344-51.</ref> | ||
* "Perianal block is a safe, feasible, reliable, and reproducible mode of anesthesia." <ref>Bharathi, R. et al. Evidence based switch to perianal block for ano-rectal surgeries. International Journal of Surgery. 2010; 8:29–31</ref> | *"Perianal block is a safe, feasible, reliable, and reproducible mode of anesthesia." <ref>Bharathi, R. et al. Evidence based switch to perianal block for ano-rectal surgeries. International Journal of Surgery. 2010; 8:29–31</ref> | ||
==Indications== | ==Indications== | ||
* [[Rectal foreign body | *[[Rectal foreign body]] removal | ||
* [[External hemorrhoid excision]] | *[[External hemorrhoid excision]] | ||
* [[Rectal prolapse]] | *[[Rectal prolapse]] | ||
*[[Anorectal abscess]] | *[[Anorectal abscess]] | ||
==Contraindications== | ==Contraindications== | ||
* Overlying | *Overlying infection | ||
* Allergy to | *Allergy to chosen anesthetic | ||
* Uncooperative | *Uncooperative patient | ||
==Equipment Needed== | ==Equipment Needed== | ||
* 20 cc Syringe with a 27 Gauge Needle | *20 cc Syringe with a 27 Gauge Needle | ||
* Spare 18 Gauge Needle (to draw up anesthetic) | *Spare 18 Gauge Needle (to draw up anesthetic) | ||
* Local Anesthetic (e.g. [[Lidocaine]] or [[Bupivacaine]]) | *Local Anesthetic (e.g. [[Lidocaine]] or [[Bupivacaine]]) | ||
* Silk Tape | *Silk Tape | ||
* Pillow or Blankets | *Pillow or Blankets | ||
* Packaged, Moist Towelette | *Packaged, Moist Towelette | ||
==Procedure<ref>Nystrom, PO. et al. Local perianal block for anal surgery. Tech Coloproctol. 2004; 8(1):23-6</ref>== | ==Procedure<ref>Nystrom, PO. et al. Local perianal block for anal surgery. Tech Coloproctol. 2004; 8(1):23-6</ref>== | ||
*Obtain informed consent | |||
* Obtain | *Place the patient in the prone position, placing either a pillow or blankets under their hips for comfort and ideal positioning | ||
* Place the patient in the prone position, placing either a pillow or blankets under their hips for comfort and ideal positioning | *Using tape, separate the patient's buttocks from one another to better visualize the perianal area | ||
* Using tape, separate the patient's buttocks from one another to better visualize the perianal area | *Draw up anesthetic into 20 cc syringe using 18 Gauge Needle | ||
* Draw up anesthetic into | *Ensure that the perianal area is clean by removing debris with moist towelette | ||
* Ensure that the perianal area is clean by removing debris with | *Peripheral to the anal sphincter, choose multiple injection sites that allow for fanning circumferentially around the anus | ||
* Peripheral to the anal sphincter, choose multiple injection sites that allow for fanning circumferentially around the anus | *Advance 27 Gauge needle into one of these preselected areas | ||
* Advance | *Aspirate to rule out intravascular placement prior to injecting 3 -5 mL of anesthetic | ||
* Aspirate to rule out intravascular placement prior to injecting 3 -5 mL of anesthetic | *Continue to the other preselected areas, fanning the needle circumferentially in order to surround the anal area with local anesthetic | ||
* Continue to the other preselected areas, fanning the needle circumferentially in order to surround the anal area with local anesthetic | |||
==Complications== | ==Complications== | ||
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==External Links== | ==External Links== | ||
==References== | ==References== | ||
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[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:GI]] | |||
Revision as of 05:14, 6 February 2017
Overview
- Perianal blocks have been shown to be comparable to general anesthesia for in terms of pain control in anal procedures including surgeries [1]
- "Perianal block is a safe, feasible, reliable, and reproducible mode of anesthesia." [2]
Indications
Contraindications
- Overlying infection
- Allergy to chosen anesthetic
- Uncooperative patient
Equipment Needed
- 20 cc Syringe with a 27 Gauge Needle
- Spare 18 Gauge Needle (to draw up anesthetic)
- Local Anesthetic (e.g. Lidocaine or Bupivacaine)
- Silk Tape
- Pillow or Blankets
- Packaged, Moist Towelette
Procedure[3]
- Obtain informed consent
- Place the patient in the prone position, placing either a pillow or blankets under their hips for comfort and ideal positioning
- Using tape, separate the patient's buttocks from one another to better visualize the perianal area
- Draw up anesthetic into 20 cc syringe using 18 Gauge Needle
- Ensure that the perianal area is clean by removing debris with moist towelette
- Peripheral to the anal sphincter, choose multiple injection sites that allow for fanning circumferentially around the anus
- Advance 27 Gauge needle into one of these preselected areas
- Aspirate to rule out intravascular placement prior to injecting 3 -5 mL of anesthetic
- Continue to the other preselected areas, fanning the needle circumferentially in order to surround the anal area with local anesthetic
Complications
See Also
External Links
References
- ↑ Gerjy, R. et al. Randomized clinical trial of stapled haemorrhoidopexy performed under local perianal block versus general anaesthesia. Br J Surgy. 2008; 95(11):1344-51.
- ↑ Bharathi, R. et al. Evidence based switch to perianal block for ano-rectal surgeries. International Journal of Surgery. 2010; 8:29–31
- ↑ Nystrom, PO. et al. Local perianal block for anal surgery. Tech Coloproctol. 2004; 8(1):23-6