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Evaluation of Postoperative Headache, Back Pain and Urinary Retention

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Evaluation of Postoperative Headache, Back Pain and Urinary Retention DOI: 10.4274/tjcd.48378 Turk J Colorectal Dis 2017;27:130-133 RESEARCH ARTICLE Evaluation of Postoperative Headache, Back Pain and Urinary Retention in Benign Anorectal Surgical Patients Under Spinal Anesthesia Spinal Anestezi Altında Selim Anorektal Cerrahi Hastalarında Postoperatif Baş Ağrısı, Bel Ağrısı ve İdrar Retansiyonunun Değerlendirilmesi Mehmet Buğra Bozan1, Burhan Hakan Kanat1, Ahmet Bozdağ1, Ali Aksu1, Nizamettin Kutluer1, Barış Gültürk1, Zeynep Özkan1, Ayşe Azak Bozan2, Abdullah Böyük1 1University of Health Sciences, Elazığ Training and Research Hospital, Clinic of General Surgery, Elazığ, Turkey 2University of Health Sciences, Elazığ Training and Research Hospital, Clinic of Anesthesiology and Reanimation, Elazığ, Turkey ABSTRACT Aim: Benign anorectal diseases are common surgical procedures in general surgery. Various anesthetic techniques are utilized during surgical procedures. In this study, postoperative headache, urinary retention, and back pain were evaluated in patients operated under spinal anesthesia. Method: The incidence of postoperative headache, urinary retention and back pain was evaluated in patients operated under spinal anesthesia for benign anorectal disease (hemorrhoidal disease, pilonidal cyst, anal abscess, anal polyps, anal fissure, and anal fistulas) between January 1, 2016 and January 1, 2017. Patients for whom data was not available or who were operated under general or local anesthesia were excluded from the study. Results: Of the 302 patients whose data could be reached, 242 (80.1%) were operated under spinal anesthesia, 56 (18.5%) were operated under local anesthesia, and 4 (1.3%) were operated under general anesthesia within the 1-year period evaluated. Patients operated under spinal anesthesia included 152 (62.8%) patients with pilonidal cyst, 29 (12%) with hemorrhoidal disease, 41 (16.9%) with anal fistulas, 13 (5.4%) with anal abscess, 5 (2.1%) with anal fissures, and 2 (0.8%) with anal polyps. Postoperative headache was seen in 6 (2.5%) of the patients operated under spinal anesthesia, 3 (50%) of whom required rehospitalization for headache. The patients were treated conservatively with fluid replacement, caffeine, and nonsteroidal anti-inflammatory therapy. Urinary retention was seen in 6 (2.5%) patients and treated with temporary urinary catheterization. Permanent urinary retention was not seen any of the patients. None (0%) of the patients had back pain. Conclusion: Spinal anesthesia has low complication rates and can be a preferred anesthetic technique for benign anorectal disease surgery. Keywords: Spinal anesthesia, benign anorectal diseases, headache, urinary retention, back pain ÖZ Amaç: Selim anorektal hastalıklar genel cerrahi pratiğinde yaygın olarak yapılan ameliyatlardır. Cerrahi prosedürde işlem için farklı anestezi tipleri tercih edilebilmektedir. Spinal anestezi altında opere edilen hastalarda postoperatif baş ağrısı, idrar retansiyonu ve bel ağrısı şikayetlerinin oranları değerlendirildi. Yöntem: 1 Ocak 2016 ila 1 Ocak 2017 tarihleri arasında kliniğimizde benign anorektal hastalıklar (hemoroidal hastalık, pilonidal sinüs, anal apse, anal polip, anal fissür ve fistül) nedeniyle spinal anestezi altında opere edilen hastalarda postoperatif baş ağrısı, idrar retansiyonu ve bel ağrısı şikayetlerinin oranları değerlendirildi. Verilerine ulaşılamayan, genel anestezi veya lokal anestezi altında opere edilen hastalar çalışmadan çıkarıldı. Bulgular: Benign anorektal hastalıklar nedeniyle bir yıl süre içerisinde 302 opere edilen hastanın 242’si spinal anestezi (%80,1), 56’sı lokal anestezi (%18,5), 4’ü genel anestezi (%1,3) altında opere edildi. Spinal anestezi uygulananlarun 152’si (%62,8) pilonidal sinüs, 29’u (%12) hemoroid, 41’i (%16,9) anal fistül, 5’i (%2,1) anal fissür, 2’si (%0,8) anal polip ve 13’ü (%5,4) anal apseydi. Spinal anestezi uygulanan hastaların 6’sında (%2,5) baş ağrısı izlenirken 3’ü (%50) tekrar yatış gerektirdi. Tüm hastalar konservatif (sıvı replasmanı, kafein, steroid yapıda olmayan anestezikler) olarak tedavi edildi. Altı hastada (%2,5) idrar retansiyonu izlendi ve geçici idrar kateterizasyonu ile tedavi edildi. Kalıcı idrar retansiyonu izlenmedi. Hiçbir hastada bel ağrısı şikayeti izlenmedi (%0). Sonuç: Benign anorektal hastalıkların cerrahisinde spinal anestezi düşük komplikasyon oranları ile uygulanabilen bir anestezi tekniğidir. Anahtar Kelimeler: Spinal anestezi, selim anorektal hastalıklar, baş ağrısı, idrar retansiyonu, bel ağrısı Address for Correspondence/Yazışma Adresi: Mehmet Buğra Bozan MD University of Health Sciences, Elazığ Training and Research Hospital, Clinic of General Surgery, Elazığ, Turkey Phone: +90 530 341 50 44 E-mail: [email protected] ORCID ID: orcid.org/0000-0001-5573-2645 Received/Geliş Tarihi: 16.10.2017 Accepted/Kabul Tarihi: 29.11.2017 This study was presented as an oral presentation (SB-068) at the 16th Turkish Society of Colon and Rectal Surgery Congress in Antalya on 16-20 May, 2017. ©Copyright 2017 by Turkish Society of Colon and Rectal Surgery Turkish Journal of Colorectal Disease published by Galenos Publishing House. 130 Bozan et al. Headache, Backache and Urinary Retantion After Spinal Anesthesia in Benign Anorectal Surgery 131 Introduction Results Benign anorectal diseases (such as hemorrhoidal disease, The files of 302 patients who had been operated within anal fissures, anal fistulas, anal abscesses, and anal polyps) the one-year period between January 1, 2016 and January present a wide-scale problem in surgical practice.1,2,3,4,5 In 1, 2017 at our hospital and whose information could be addition to different surgical techniques, different anesthetic accessed were retrospectively reviewed. Of these patients, procedures (general anesthesia, spinal anesthesia and other 242 (80.1%) had surgery under spinal anesthesia, 56 blocks, local anesthesia) are also performed.6 Patients may (18.5%) with local anesthesia, and 4 (1.3%) under general experience postoperative problems related to both surgery anesthesia. The 60 patients who had been operated under and anesthesia. Complications related to anesthesia are general or local anesthesia were excluded from the study. especially challenging for surgeons. Surgical indication for the patients operated under spinal anesthesia was pilonidal sinus for 152 (62.8%), hemorrhoids In this study, we evaluated patients who underwent benign for 29 (12%), anal fistula for 41 (16.9%), anal abscess for anorectal surgery under spinal anesthesia for headache, 13 (5.4%), anal fissure for 5 (2.1%), and anal polyps for 2 back pain, and urinary retention, which are common (0.8%) of the patients. postoperative complications of spinal anesthesia. Of the 242 patients in the study, 206 (85.1%) were male and Materials and Methods 36 (14.9%) were female. The mean age of the entire patient group was 28.17±9.94 years (17-61 years). The mean age of After obtaining institutional approval, we retrospectively male patients was 28.21±10.39 years (17-61 years), while reviewed the files of 302 patients who had been operated the mean age of female patients was 27.92±6.93 years (17- for benign anorectal diseases (pilonidal sinus, hemorrhoidal 40 years). disease, anal fistulas, anal fissures, anal abscesses, and anal Analysis of disease distribution by gender showed that of polyps) between January 1, 2016 and January 1, 2017 at the the 206 male patients, 137 (66.5%) had pilonidal sinus, University of Health Sciences Elazığ Training and Research 22 (10.7%) had hemorrhoids, 34 (16.5%) had anal fistula, Hospital Clinic of General Surgery in accordance with the 11 (5.3%) had anal abscess, and 2 (1%) had anal fissure. 2013 Declaration of Helsinki. Patients whose files were Among the 36 female patients, 15 (41.7%) had pilonidal incomplete or inaccessible and those who were operated sinuses, 7 (19.4%) had hemorrhoidal disease, 7 (19.4%) had under general or local anesthesia were excluded from the anal fistula, 3 (8.3%) had anal fissures, 2 (5.6%) had anal study. A total of 242 patients whose surgery was performed abscesses, and 2 (5.6%) had anal polyps (5.6%). under spinal anesthesia were included in the study. Data Evaluation of postoperative complications after spinal were collected from the patient’s medical records and anesthesia revealed that 6 (2.5%) of the patients experienced readmission records and information about postoperative headache, and 3 (50%) of these patients required problems was obtained via telephone interviews. The readmission. Five of the patients with headache were demographic data of patients included in the study (age, male and 1 was female. There were no significant gender gender), their reasons for undergoing surgery, anesthesia- Table 1. Complications of spinal anesthesia according to related complications (headache, back pain, and urinary gender retention), and the distribution of spinal anesthesia by age Complications Gender p group (<20 years, 20-40 years, 40-60 years, and >60 years) were evaluated. Patients signed an informed consent form Male Female for the surgical procedure and subsequent treatment, and the Postoperative headache Yes 5 1 0.9 necessary permission was obtained to use their data in our No 201 35 analyses. Obtaining the consent of an ethics committee was Urinary retention Yes 6 0 0.3 not necessary for this retrospective clinical study. However, No 200 36 consent was obtained from the hospital management for processing the data. Back pain Yes 0 0 - No 206 36 Statistical Analysis Readmission Yes 2 1 0.37 SPSS software, version 15.0 was used for the statistical
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