Background and Goal of Study: Spinal saddle block (SSB) is superior to total intravenous anaesthesia (TIVA) in patients undergoing perianal surgery in the lithotomy position in terms of multiple aspects . Currently it is unknown, whether pilonidal sinus operations performed in the prone position, do also profit from a SSB. The aim of this randomized clinical trial was to determine whether SSB is superior to TIVA in terms of recovery times, postoperative complications and analgesic consumption in patients undergoing pilonidal sinus operations in the prone position.
Materials and Methods: After approval of a positive ethical vote (Ethics Commision II, Faculty for Clinical Medicine, Mannheim, Germany, vote: 2010-215N-MA) suitable patients aged 18-80 years and American Society of Anesthesiologists grade I-III scheduled for pilonidal sinus operations in the prone position were randomized to SSB (1,5 ml hyperbaric bupivacaine 0,5%) or TIVA (propofol, fentanyl and mivacurium by means of an endotracheal tube). Cumulative consumption of analgesics within 24 hours after surgery was recorded, and postoperative recovery and patient satisfaction were evaluated.
Results and Discussion: A total of 23 patients (two females, age 28,9±7,1 years, height 178±8 cm, weight 86,4 ±19,6 kg) were randomized within a five-months-period. Average monitoring time in the recovery room was 9,8±6,3 min for SSB vs. 41±23 min for TIVA (p=0,0003). Patients in the SSB group were able to drink (49,6±46,4 min vs. 154±64,7 min, p=0,0007) and eat (140,4±57,7 min vs. 238±95,5 min, p=0,01) earlier although times to mobilization and micturition were not significantly different. Patients with TIVA suffered more frequently from a sore throat (n=5 vs. n=0, p=0,0011) and needed more additional analgetics (n=4 vs. n=0, p=0,0237). Two patients in the TIVA group suffered from nausea and vomiting. Patients of both groups were equally satisfied with the anaesthesia technique offered.
Conclusion(s): SSB is superior to TIVA in patients undergoing pilonidal sinus operations in the prone position in terms of recovery times, postoperative complications and analgesic consumption.
 Schmittner MD, Schreiber H, Janke A, Weiss C, Blunk J, Bussen DG, Luecke T (2010) Randomised clinical trial of anorectal surgery performed under spinal saddle block versus total intravenous anaesthesia. Br J Surg 97(1): 12-20