Anorectal manometry assessment of sphincter relaxation after local-regional anesthesia with posterior perineal block

Abstract

INTRODUCTION: Since the 1970s, in the USA, we witnessed a progressive increase of one-day surgical procedures. This attitude soon gained ground in Europe as well. In proctology, this kind of clinical approach has always been limited by the acute sensitivity of the anal- perineal area and by difficulties in attaining a complete sphincter relaxation with local anesthesia. Posterior perineal block seems to be associated with both a good pain control and an effective sphincter relaxation.

MATERIAL AND METHODS: Between January 2017 and January 2018, we enrolled in our study 33 patients suffering from hemorrhoidal disease. They were all subjected to posterior perineal block. We measured anal resting pressure and squeeze pressure before and after anesthesia. Measurements where taken 5 minutes before and 15 minutes after the administration of local.

RESULTS: We registered an average decrease of 39,2% of resting pressure and of 45,4% of squeeze pressure.

CONCLUSIONS: We may state that perineal posterior block, while reducing striated muscle contractile activity, also causes a relevant reduction of anal basal tone. During surgical procedures done under regional anesthesia, we experienced a good sphincter relaxation, which was comparable, if not equal, to that induced by general anesthesia. In fact, 10 to 15 minutes after performing the block you could observe the elevation of the inferior margin of the exterior sphincter and the concomitant descent of the inferior margin of the internal sphincter (coaxial dislocation).