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Abstract
COMPARISON OF SADDLE VERSUS CAUDAL EPIDURAL ANESTHESIA IN THE MANAGEMENT OF PATIENTS UNDERGOING AMBULATORY PERIANAL SURGERY
Dr. Hiyam Mohsin Abbas Al-Dahlaki*, Assist. Prof. Dr. Ali Hadi Mosleh Al-Ma’ini and
Dr. Mohammed Mahir Abdulelah
ABSTRACT
Background: Choosing the right anesthesia is vital for optimal patient comfort and surgical outcomes in anorectalsurgery. Saddle and caudal epidural blocks, while both managing pain, vary in effectiveness, safety, and impact onperioperative factors. Aim of the study: The study aims to compare between the caudal block and saddle blockregarding the onset of action, duration and hemodynamic changes, also assessing postoperative pain levels andpatient satisfaction in patients undergoing anorectal surgery. Patients and methods: This prospective randomizedclinical trial was conducted from August, 2022 to September, 2023 at Baghdad Teaching Hospital and Al-ImamainAl-Kadhimain Medical City, involving sixty adult patients who were scheduled for perianal surgery. Thirtypatients received spinal saddle anesthesia and the other 30 received caudal epidural block. Data collectioninvolved demographics, anthropometrics, operation time, onset of sensory block. In addition, the modifiedBromage scale, heart rate, mean arterial pressure were recorded at distinct time points. Post-operative pain, patientand surgeon satisfaction were also recorded. Results: Study baseline characteristics (age, sex, BMI, and ASA)were similar between the two study groups. Caudal epidural group exhibited a delayed sensory block onset timecompared to the saddle block (13.5 ± 3.0 versus 3.8 ± 1.8 min, P-value < 0.001). Heart rate and mean arterialpressure were comparable between the groups. Caudal epidural group was better at preserving motor functionintra-and postoperatively. Although the saddle block group reported higher pain scores at the 12-hour mark (3.8 ±1.3 versus 2.5 ± 1.3, P-value < 0.001), overall patient satisfaction was significantly better in saddle block groupcompared to the caudal epidural group (P-value < 0.001); while surgeon satisfaction was similar between bothgroups. Conclusion: Both anesthesia groups maintained similar hemodynamic stability. Caudal epiduraldemonstrated delayed sensory block onset, nonetheless better in preserving motor function. Although caudal blockprovided superior pain control, overall patient satisfaction was higher with saddle block anesthesia.
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