Comparison of spinal versus caudal epidural anesthesia in the management of patients undergoing ambulatory perianal surgery: Randomized, prospective study

Cigdem Bozkurt 1, Engin Erturk 2, Ali Akdogan 2 * , Tugrul Kesicioglu 3, Ismail Aydin 3
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1 Department of Anesthesiology and Critical Care, Faculty of Medicine, Giresun University, Giresun, Turkey
2 Department of Anesthesiology and Critical Care, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
3 Department of General Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 5, pp. 76-81.
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Objective: To compare levobupivacaine based caudal epidural anesthesia and spinal anesthesia in terms of Intraoperative hemodynamic changes and postoperative pain and patient comfort in subjects undergoing perianal surgery in outpatient setting.
Material and methods: All consecutive patients who were scheduled for perianal surgery. The difference in intraoperative hemodynamic changes, sensory and motor block level, postoperative pain and patient comfort was the primary outcome measure of this study.
Results: There were no significant differences between the groups in terms of mean arterial pressure and heart rate recorded. Subjects randomized to spinal anesthesia had a significantl extensive motor and sensory block compared to those randomized to caudal epidural anesthesia. Visual analogue scale scores for surgical pain at postoperative 12 hours was significantly higher in subjects receiving spinal anesthesia compared to those receiving caudal epidural anesthesia (p< 0.05). Time to first analgesic administration was significantly lower in subjects randomized to spinal anesthesia compared to those receiving caudal epidural anesthesia (p< 0.01).
Conclusion: Spinal anesthesia is associated with more extensive sensory and motor block compared to caudal epidural anesthesia in patients undergoing perianal surgery. Both techniques lead to similar hemodynamic changes. Postoperative pain control is more favorable with caudal block than the spinal anesthesia.


Bozkurt C, Erturk E, Akdogan A, Kesicioglu T, Aydin I. Comparison of spinal versus caudal epidural anesthesia in the management of patients undergoing ambulatory perianal surgery: Randomized, prospective study. J CLIN MED KAZ. 2021;18(5):76-81.


  • Ojo EO. Day case surgery and developing countries: a review. Niger J Clin Pract. 2010 Dec;13(4):459-66. PMID: 21220866.
  • Alley EA, Mulory MF. Neuraxial anesthesia for outpatients. Anesthesiol Clin. 2014 Jun;32(2):357-69. doi: 10.1016/j.anclin.2014.02.007. PMID: 24882123.
  • Gabriel RA, Ilfeld BM. Use of Regional Anesthesia for Outpatient Surgery Within the United States: A Prevalence Study Using a Nationwide Database. Anesth Analg. 2018 Jun;126(6):2078-2084. doi: 10.1213/ANE.0000000000002503. PMID: 28922231.
  • Li J, Lam D, King H, Credaroli E, Harmon E, Vadivelu N. Novel Regional Anesthesia for Outpatient Surgery. Curr Pain Headache Rep. 2019 Aug 1;23(10):69. doi: 10.1007/s11916-019-0809-6. PMID: 31372836.
  • Mulroy MF, McDonald SB. Regional anesthesia for outpatient surgery. Anesthesiol Clin North Am. 2003 Jun;21(2):289-303. doi: 10.1016/s0889-8537(02)00071-8. PMID: 12812396.
  • Gebhardt V, Kiefer K, Bussen D, Weiss C, Schmittner MD. Retrospective analysis of mepivacaine, prilocaine and chloroprocaine for low-dose spinal anaesthesia in outpatient perianal procedures. Int J Colorectal Dis. 2018 Oct;33(10):1469-1477. doi: 10.1007/s00384-018-3085-8. Epub 2018 May 13. PMID: 29756162.
  • Jamshidi R. Anorectal Complaints: Hemorrhoids, Fissures, Abscesses, Fistulae. Clin Colon Rectal Surg. 2018 Mar;31(2):117-120. doi: 10.1055/s-0037-1609026. Epub 2018 Feb 25. PMID: 29487494; PMCID: PMC5825861.
  • Gerjy R, Lindhoff-Larson A, Sjödahl R, Nyström PO. Randomized clinical trial of stapled haemorrhoidopexy performed under local perianal block versus general anaesthesia. Br J Surg. 2008 Nov;95(11):1344-51. doi: 10.1002/bjs.6379. PMID: 18844245.
  • Stokes R, Wanaguru D, Saadi A, Adams S. Management of perianal abscesses in infants without general anaesthesia: a systematic review of the literature. Pediatr Surg Int. 2020 Nov;36(11):1317-1325. doi: 10.1007/s00383-020-04728-7. Epub 2020 Aug 12. PMID: 32785778.
  • Bussen D, Sailer M, Fuchs KH, Thiede A. Tumeszenz-Lokalanästhesie bei proktologischen Eingriffen [Tumescent local anesthesia in proctologic surgery]. Chirurg. 2003 Sep;74(9):839-43. German. doi: 10.1007/s00104-003-0670-2. PMID: 14504797.
  • Falco N, Tutino R, Fontana T, Gullo R, Licari L, Raspanti C et al. Outpatient management of proctologic disease. Which techniques for local anesthesia? The experience of a single center. G Chir. 2019 May-Jun;40(3):182-187. PMID: 31484006.
  • Gerjy R, Derwinger K, Nyström PO. Perianal local block for stapled anopexy. Dis Colon Rectum. 2006 Dec;49(12):1914-21. doi: 10.1007/s10350-006-0750-8. PMID: 17080277.
  • Boublik J, Gupta R, Bhar S, Atchabahian A. Prilocaine spinal anesthesia for ambulatory surgery: A review of the available studies. Anaesth Crit Care Pain Med. 2016 Dec;35(6):417-421. doi: 10.1016/j.accpm.2016.03.005. Epub 2016 Jun 21. PMID: 27352633.
  • Wassef MR, Michaels EI, Rangel JM, Tsyrlin AT. Spinal perianal block: a prospective, randomized, double-blind comparison with spinal saddle block. Anesth Analg. 2007 Jun;104(6):1594-6, table of contents. doi: 10.1213/01.ane.0000261510.37489.00. PMID: 17513664.
  • Chan VW, Garcia J, Al-Kaisy A, Drasner K. A comparative study of low-dose hyperbaric spinal lidocaine 0.5% versus 5% for continuous spinal anesthesia. Reg Anesth Pain Med. 1998 Mar-Apr;23(2):164-9. doi: 10.1097/00115550-199823020-00009. PMID: 9570605.
  • Kazak Z, Ekmekci P, Kazbek K. Hyperbaric levobupivacaine in anal surgery : Spinal perianal and spinal saddle blocks. Anaesthesist. 2010 Aug;59(8):709-13. doi: 10.1007/s00101-010-1755-1. Epub 2010 Jul 30. PMID: 20668826.
  • Schmittner MD, Schreiber H, Janke A, Weiss C, Blunk J, Bussen DG, Luecke T. Randomized clinical trial of perianal surgery performed under spinal saddle block versus total intravenous anaesthesia. Br J Surg. 2010 Jan;97(1):12-20. doi: 10.1002/bjs.6792. PMID: 19937984.
  • LEWIS MS, AUSTIN RB. Continuous caudal versus saddle-block anesthesia in obstetrics. Am J Obstet Gynecol. 1950 May;59(5):1146-52. doi: 10.1016/s0002-9378(16)39184-0. PMID: 15410836.
  • Satoh M, Hasebe K, Tsujimoto Y, Takada T, Honda M, Fujioka H. [Examination of the anesthesia on transperineal prostate biopsy--saddle block versus caudal block]. Hinyokika Kiyo. 2005 Jul;51(7):443-5. Japanese. PMID: 16119806.
  • Seyedhejazi M, Moghadam A, Sharabiani BA, Golzari SE, Taghizadieh N. Success rates and complications of awake caudal versus spinal block in preterm infants undergoing inguinal hernia repair: A prospective study. Saudi J Anaesth. 2015 Oct-Dec;9(4):348-52. doi: 10.4103/1658-354X.154704. PMID: 26543447; PMCID: PMC4610074.
  • Kaban OG, Yazicioglu D, Akkaya T, Sayin MM, Seker D, Gumus H. Spinal anaesthesia with hyperbaric prilocaine in day-case perianal surgery: randomised controlled trial. ScientificWorldJournal. 2014;2014:608372. doi: 10.1155/2014/608372. Epub 2014 Oct 14. PMID: 25379541; PMCID: PMC4214037.
  • Watson B, Howell V. Spinal anaesthesia: the saviour of day surgery? Current Anaesthesia & Critical Care 2007; 18: 193-199. DOI: 10.1016/j.cacc.2007.07.004
  • Gudaityte J, Marchertiene I, Karbonskiene A, Saladzinskas Z, Tamelis A, Toker I, Pavalkis D. Low-dose spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blinded, randomized, controlled study. J Clin Anesth. 2009 Nov;21(7):474-81. doi: 10.1016/j.jclinane.2008.11.014. PMID: 20006254.
  • Imbelloni LE, Gouveia MA, Cordeiro JA. Hypobaric 0.15% bupivacaine versus hypobaric 0.6% lidocaine for posterior spinal anesthesia in outpatient anorectal surgery. Rev Bras Anestesiol. 2010 Mar-Apr;60(2):113-20, 64-8. English, Portuguese, Spanish. doi: 10.1016/s0034-7094(10)70015-5. PMID: 20485955.
  • Gudaityte J, Marchertiene I, Pavalkis D. Anesthesia for ambulatory anorectal surgery. Medicina (Kaunas). 2004;40(2):101-11. English, Lithuanian. PMID: 15007268.
  • Gudaityte J, Marchertiene I, Pavalkis D, Saladzinskas Z, Tamelis A, Tokeris I. Spinalinio hiperbarinio bupivakaino minimali veiksminga doze darant anorektalines operacijas (dvigubai aklas atsitiktiniu imciu tyrimas) [Minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blind, randomized study]. Medicina (Kaunas). 2005;41(8):675-84. Lithuanian. PMID: 16160416.
  • Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001 May;94(5):888-906. doi: 10.1097/00000542-200105000-00030. PMID: 11388543.
  • Hampl KF, Schneider MC, Ummenhofer W, Drewe J. Transient neurologic symptoms after spinal anesthesia. Anesth Analg. 1995 Dec;81(6):1148-53. doi: 10.1097/00000539-199512000-00006. PMID: 7486096.
  • Dahlgren N. Lidocaine toxicity: a technical knock-out below the waist? Acta Anaesthesiol Scand. 1998 Apr;42(4):389-90. doi: 10.1111/j.1399-6576.1998.tb05130.x. PMID: 9563855.
  • Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg. 2002 Jan;94(1):188-93, table of contents. doi: 10.1097/00000539-200201000-00036. PMID: 11772826.
  • Adebamowo CA, Ladipo JK, Ajao OG. Randomized comparison of agents for caudal anaesthesia in anal surgery. Br J Surg. 1996 Mar;83(3):364-5. doi: 10.1002/bjs.1800830321. PMID: 8665193.
  • Chan MT, Lam KK. Randomized comparison of agents for caudal anaesthesia in anal surgery. Br J Surg. 1996 Sep;83(9):1300. PMID: 8983632.
  • Wang N, Fu Y, Ma H, Wang J, Gao Y. Advantages of caudal block over intrarectal local anesthesia plus periprostatic nerve block for transrectal ultrasound guided prostate biopsy. Pak J Med Sci. 2016;32(4):978-982. doi:10.12669/pjms.324.9823
  • Villalobos MA, Veneziano G, Miller R, Beltran RJ, Krishna S, Tumin D et al. Evaluation of postoperative analgesia in pediatric patients after hip surgery: lumbar plexus versus caudal epidural analgesia. J Pain Res. 2019 Mar 18;12:997-1001. doi: 10.2147/JPR.S191945. PMID: 31118744; PMCID: PMC6498965.
  • Dawkins CJ. An analysis of the complications of extradural and caudal block. Anaesthesia. 1969 Oct;24(4):554-63. doi: 10.1111/j.1365-2044.1969.tb02909.x. PMID: 4242599.
  • Kao SC, Lin CS. Caudal Epidural Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017;2017:9217145. doi: 10.1155/2017/9217145. Epub 2017 Feb 26. PMID: 28337460; PMCID: PMC5346404.
  • Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019 Apr;122(4):509-517. doi: 10.1016/j.bja.2018.11.030. Epub 2019 Feb 1. PMID: 30857607; PMCID: PMC6435837.
  • Tetzlaff JE. Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine. Mayo Clin Proc. 2010 Jul;85(7):e51. doi: 10.4065/mcp.2010.0230. PMCID: PMC2894732.