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Year : 2018  |  Volume : 13  |  Issue : 3  |  Page : 130-134

Local infiltration anaesthesia for lateral internal anal sphincterotomy; a safe and effective alternative to regional or general anaesthesia

Department of Surgery, Osmania Medical College, Hyderabad, Telangana, India

Correspondence Address:
Dr. Gayatri Priyanka Gadiraju
Department of Surgery, Osmania Medical College, Hyderabad, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_46_18

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Background: Chronic fissure in ano is one of the most common anal disorders in all age groups which causes significant distress to the patient even though the disease is benign in nature. Several treatment options are available ranging from medical to surgical of which surgical division of sphincter, lateral internal anal sphincterotomy, is one the most common surgical procedures done to relieve anal sphincter spasm and aid healing of fissure. Most commonly, surgery for fissure in ano is performed under regional or general anesthesia due to severe pain associated with disease. Patient acceptance is also low as the perianal area is very sensitive to pain which may be aggravated by patient positioning during surgery. Materials and Methods: This is a prospective study was done in Osmania General Hospital over a period of 3 years in patients who were treated in our unit with acute and chronic fissure in ano. All patients were counseled regarding disease and treatment options. Informed and written consent was obtained from all patients willing to undergo sphincterotomy under local anesthesia. These patients include females and males >15 years of age and also patients having medical comorbid conditions, such as chronic obstructive pulmonary disease, uncontrolled diabetes, and others in whom surgery under regional or general anesthesia was deferred or contraindicated due to high risk. Results: All lateral internal anal sphincterotomies were performed under local anesthesia. There was significant pain relief following surgery. Intraoperative complications related to administration and drug, and surgery were negligible, and the duration of surgery was very less compared to regional or general anesthesia cases. Patient acceptance was also very good as local anesthesia provided good pain relief during and after surgery and fissure healing rates were high with less complications and no recurrences. Conclusion: Local infiltrative anesthesia is a very effective and safe form of anesthesia for lateral anal sphincterotomy for acute and chronic fissure in ano in terms of minimal complications, ease of giving anesthesia, and cost-effective as no extensive pre-operative preparation and investigations are required. It can also be safely administered in all age group, and also in patients with medical comorbid conditions which precludes administration of spinal or general anesthesia.

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