1. Introduction Anorectal surgery is an important means to treat anorectal diseases such as hemorrhoids, anal fistula and anal fissure. Appropriate anesthesia plays an important role in the smooth operation, the comfort of patients and the recovery after operation. Sacral anesthesia and spinal anesthesia are two commonly used anesthesia methods in anorectal surgery, each of which has its own characteristics and needs to be selected according to the specific conditions of patients in clinical application.
2. Application
of sacral anesthesia in anorectal surgery
(1) Anatomical basis of the sacral canal The sacral canal is the continuation of the spinal canal in the sacrum and is located in the sacrum. It contains abundant nerves, mainly innervating the perineum, around the anus and some areas of the lower limbs. Understanding the anatomy of the sacral canal is essential for accurate administration of caudal anesthesia. Sacral hiatus is an important body surface landmark of sacral anesthesia, and its location and shape may be different in different individuals.
(2) Anesthetic procedures Patients usually lie in the lateral or prone position. After strict sterilization, puncture was performed through the sacral hiatus. The sign of successful puncture is that there is an obvious sense of emptiness. After drawing back without blood and cerebrospinal fluid, local anesthetics are slowly injected. Commonly used local anesthetics include lidocaine and ropivacaine. The dosage of drugs needs to be determined according to the patient’s age, weight and the extent of surgery.
(3) Advantages 1. For the operation around the anus and perineum, caudal anesthesia can provide good local anesthesia effect and effectively block the pain conduction in the operation area. 2. Compared with spinal anesthesia, the operation is relatively simple and the technical requirements are relatively low, especially for less experienced anesthesiologists. 3. There are relatively few complications and less physiological interference to patients, such as the impact on respiratory and circulatory systems is not as obvious as spinal anesthesia.
(4) Disadvantages 1. There may be individual differences in the effect of anesthesia, and some patients may have incomplete anesthesia, which requires local infiltration anesthesia. 2. Because of the anatomical variation of the sacral canal, puncture may be difficult and even fail.
3. Application
of spinal anesthesia in anorectal surgery
(1) Anatomical basis of the spinal canal The spinal canal is formed by connecting the vertebral foramens of multiple vertebrae, and contains important structures such as the spinal cord and spinal nerve roots. In anorectal surgery, it mainly involves low spinal anesthesia, including spinal anesthesia and epidural anesthesia. Spinal anesthesia is the injection of local anesthetics into the subarachnoid space, while epidural anesthesia is the injection of drugs into the epidural space.
(2) Anesthesia operation method During lumbar anesthesia, patients usually take lateral position, select appropriate lumbar space for puncture, and inject local anesthetics into subarachnoid space after success. Epidural anesthesia is punctured in a similar manner, but the drug is injected into the epidural space. The choice and dosage of anesthetic drugs also need to be adjusted individually.
(3) Advantages 1. Anesthesia effect is exact, which can provide a wide and effective anesthesia area, and has more advantages for some complex anorectal operations or cases requiring a larger surgical field of vision. 2. Continuous anesthesia can be carried out through catheterization. For anorectal surgery with long operation time, continuous administration can be carried out to ensure the continuity of anesthesia effect.
(4) Disadvantages 1. The operation requires high technical requirements and accurate puncture skills, otherwise it may damage the spinal cord, spinal nerve roots and other important structures, leading to serious complications. 2. It has a great impact on the physiological function of patients, especially on blood pressure and respiration. Hypotension and respiratory depression may occur, which need close monitoring and timely treatment. 3. Complications such as headache and urinary retention may occur after operation, which will affect the comfort and recovery of patients.
4. The choice of two anesthesia methods needs to consider many factors when choosing caudal anesthesia or spinal anesthesia for anorectal surgery. Caudal anesthesia may be a better choice for simple minor perianal surgery, such as simple external hemorrhoidectomy. Spinal anesthesia may be more appropriate for complex anal fistula surgery, surgery involving a wide range of anorectal diseases or longer operation time. At the same time, the patient’s physical condition, such as age, cardiopulmonary function, is also an important consideration. Elderly patients or patients with poor cardiopulmonary function may be more inclined to choose caudal anesthesia with less impact on physiological function, but if surgery is needed, spinal anesthesia should be carefully selected after weighing the pros and cons, and corresponding monitoring and treatment measures should be taken.
5. Conclusion Both sacral anesthesia and spinal anesthesia have their own application value in anorectal surgery. Understanding their anesthesia principles, operation methods, advantages and disadvantages, as well as the correct choice of anesthesia methods, is of great significance for improving the quality of anorectal surgery and ensuring the safety and comfort of patients. In clinical practice, anesthesiologists need to make a comprehensive assessment according to the specific situation of patients and choose the most suitable anesthesia scheme to ensure the smooth operation and good prognosis of patients.
Anesthesia Anorectal disease (mixed hemorrhoids)
