Effect of one-minute versus two-minute sitting duration on discharge readiness following saddle spinal anesthesia with 5 mg hyperbaric bupivacaine for fistula-in-ano surgery: A randomized controlled trial

Abstract

Background: Saddle spinal anesthesia (SSA) is commonly used for ambulatory anorectal surgery. Although 1-min sitting after intrathecal hyperbaric bupivacaine has been reported to provide effective anesthesia, it has not previously been compared with another sitting duration in a randomized trial. Aims and Objectives: The aim of the study was to compare discharge readiness following 1-min versus 2-min sitting duration after SSA in patients undergoing fistula-in-ano (FIA) surgery. Materials and Methods: In this prospective, randomized, and single-blinded trial, 44 American Society of Anesthesiologists I–II patients undergoing FIA surgery received 5 mg (1 mL of 0.5% hyperbaric bupivacaine) intrathecally. Patients were allocated to Group I (1-min sitting, n=22) or Group II (2-min sitting, n=22). The primary outcome was time to achieve a Modified Post-anesthesia Discharge Scoring System (PADSS) score ≥9. Secondary outcomes included time to achieve Modified Aldrete score (MAS) ≥9, ambulation, first voiding, pain scores, hemodynamic parameters, rescue analgesic requirement, and adverse events. Results: Median time to achieve modified PADSS ≥9 was comparable between Group I and Group II (4.5 [3.75–5.25] vs. 4.5 [4.00–6.25] h; P=0.372). Time to achieve MAS ≥9, ambulation, and first voiding were similar between groups. No significant differences were observed in pain scores, hemodynamic variables, rescue analgesic requirement, or surgeon satisfaction. No patient developed urinary retention, post-operative nausea and vomiting, headache, or backache. Conclusion: One-minute sitting after low-dose SSA provides discharge readiness, recovery characteristics, and safety profile comparable to 2-min sitting in patients undergoing FIA surgery. Prolonging sitting duration beyond 1 min did not provide additional clinical benefits.