Comparison of two different anesthesia methods for the procedure for prolapse and hemorrhoids in elderly patients with anorectal diseases / 中华老年医学杂志

ABSTRACT

Objective To compare the anesthetic effects of subarachnoid anesthesia(SA)and epidural anesthesia(EA)for the procedure for prolapse and hemorrhoids(PPH)in elderly patients with benign anorectal diseases.Methods A retrospective analysis was conducted in 60 patients with benign anorectal diseases admitted to Peking University Third Hospital from March to August 2018 and undergoing PPH.According to anesthesia methods,patients were divided into the SA group and the EA group (n=30 each).The level of sensory block was tested by acupuncture,and the degree of motor block was assessed by revised Bromage score.The anesthesia effect,operation time,blood loss,adverse events and hospitalization time were compared between the two groups.Results The highest level of sensory block was similar between the two groups without significant difference(P ＞0.05).The median onset time of sensory block was longer in the EA group [270.0 s(interquartile range,66.3 s)] than in the SA group [25.5 s(interquartile range,14.3 s)].The revised Bromage score was lower in the EA group than in the SA group [1.0(interquartile range,1.0)vs.2.0 (interquartile range,1.0),Z =6.657,-1.685,both P =0.000].The risks of hypotension,nausea and vomiting,and urinary retention were lower in the EA group than in the SA group (x2 =6.405,4.286 and 4.403,P=0.011,0.038 and 0.044).There were no significant differences in anesthetic effect,operation time,blood loss and hospitalization time between the two groups (all P ＞ 0.05).Conclusions EA can provide a perfect anesthesia and analgesic effect for elderly patients receiving PPH,with the advantages of rapid recovery of limb movement and low adverse events.As a substitute for SA,EA is a suitable anesthesia method for promoting the enhanced recovery after surgery(ERAS) in patients with benign anorectal diseases.