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http://dx.doi.org/10.3344/kjp.2010.23.3.190

Is It Useful and Safe to Maintain the Sitting Position During Only One Minute before Position Change to the Jack-knife Position?  

Park, Soo-Young (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine)
Park, Jong-Cook (Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine)
Park, Sang-Hyun (Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine)
Publication Information
The Korean Journal of Pain / v.23, no.3, 2010 , pp. 190-197 More about this Journal
Abstract
Background: Conventional spinal saddle block is performed with the patient in a sitting position, keeping the patient sitting for between 3 to 10 min after injection of a drug. This amount of time, however, is long enough to cause prolonged postoperative urinary retention. The trend in this block is to lower the dose of local anesthetics, providing a selective segmental block; however, an optimal dose and method are needed for adequate anesthesia in variable situations. Therefore, in this study, we evaluated the question of whether only 1 min of sitting after drug injection would be sufficient and safe for minor anorectal surgery. Methods: Two hundred and sixteen patients undergoing minor anorectal surgery under spinal anesthesia remained sitting for 1 min after completion of subarachnoid administration of 1 ml of a 0.5% hyperbaric bupivacaine solution (5 mg). They were then placed in the jack-knife position. After surgery, analgesia levels were assessed using loss of cold sensation in the supine position. The next day, urination and 11-point numeric rating scale (NRS) for postoperative pain were assessed. Results: None of the patients required additional analgesics during surgical manipulation. Postoperative sensory levels were T10 [T8-T12] in patients, and no significant differences were observed between sex (P = 0.857), height (P = 0.065), obesity (P = 0.873), or age (P = 0.138). Urinary retention developed in only 7 patients (3.2%). In this group, NRS was $5.0{\pm}2.4$ (P = 0.014). Conclusions: The one-minute sitting position for spinal saddle block before the jack-knife position is a safe method for use with minor anorectal surgery and can reduce development of postoperative urinary retention.
Keywords
bupivacaine; complication; hyperbaric; saddle block; urinary retention;
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