Assessing the effect of drug treatment with a needle from the coccyx in patients with chronic anal fissure

A Hundred twenty consecutive patients with the diagnosis of chronic anal fissure were enrolled this randomized, controlled study. Caudal epidural injection group (Group K, n=60) was treated with 5cc bupivacain + 5cc isotonic from a caudal epidural for a total of 3 sessions at the beginning, 1 week and 2 weeks later; The patients who were taken to the surgery room were monitored using electrocardiography, arterial pressure(noninvasive) and pulse oximetry, and baseline values were recorded. 10 ml for each patient. 0.25% Bupivacaine (Marcain, OSEL) was prepared using a syringe. A pillow was placed in the pelvic region of patients in the prone position. After the area was cleaned and covered, the sacral hiatus was determined by palpation by the anesthesiologist and a 22 G 9 cm needle was pushed forward until bone was touched at a 45° angle to the skin. Then, the angle of the needle, which was withdrawn to the skin, was decreased from 20° to 5°, and it was pushed forward 5-6 cm into the epidural distance by passing through the sacrococcygeal ligament. After observing that the blood and cerebrospinal fluid did not result in negative aspiration, the prepared bupivacaine was injected.The approximate duration of each caudal epidural injection session was 15 minutes. The diagnosis of chronic anal fissure and the evaluation of the anal fissure during the caudal epidural injection(CEI) procedure were performed by an expert colorectal surgeon.