Korean J Pain.  2010 Sep;23(3):190-197. 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 SY
• Park JC
• Park SH

• KMID: 1767879
• DOI: http://doi.org/10.3344/kjp.2010.23.3.190

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 +/- 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.

Keyword

bupivacaine; complication; hyperbaric; saddle block; urinary retention

MeSH Terms

Analgesia
Analgesics
Anesthesia
Anesthesia, Spinal
Anesthetics, Local
Bupivacaine
Cold Temperature
Humans
Obesity
Pain, Postoperative
Sensation
Supine Position
Urinary Retention
Urination
Analgesics
Anesthetics, Local
Bupivacaine

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