• M D Schmittner, H Schreiber, A Janke, C Weiss, J Blunk, D G Bussen, and T Luecke.
• Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. marc.schmittner@umm.de
• Br J Surg. 2010 Jan 1; 97 (1): 12-20.

BackgroundThe aim of this randomized clinical trial was to determine whether spinal saddle block (SSB) is superior to total intravenous anaesthesia (TIVA) in perianal surgery.MethodsSuitable patients aged 18-75 years (American Society of Anesthesiologists grade I or II) scheduled to undergo perianal surgery were randomized to SSB (1.0 ml 0.5 per cent hyperbaric bupivacaine) or TIVA with propofol and fentanyl by means of a laryngeal mask. Cumulative consumption of analgesics within 24 h after surgery was recorded, and postoperative recovery and patient satisfaction were evaluated.ResultsA total of 201 patients were randomized. Supplemental analgesia within 24 h after surgery was required by 31 of 101 patients having SSB and 58 of 100 who had TIVA (P < 0.001). Median monitoring time in the recovery room was 5 (range 1-45) min for SSB versus 44 (4-148) min for TIVA (P < 0.001). Patients in the SSB group were able to eat and drink more quickly, although times to mobilization and micturition were not significantly different. Patients having SSB were more likely to describe the anaesthesia as 'better than expected'.ConclusionSSB is superior to TIVA in patients undergoing perianal surgery in terms of analgesic consumption within 24 h after surgery and aspects of postoperative recovery.Registration NumberISRCTN41981381 (http://www.controlled-trials.com).Copyright 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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