Indications
- Rectal foreign body removal
- External hemorrhoid excision
- Rectal prolapse
- Anorectal abscess drainage
Contraindications
- Infection overlying injection site
- Allergy to local anesthetic
Equipment
- 15-20cc of local anesthetic of choice
- 27G needle
- Cleansing solution
- Silk tape
- Pillow or blankets
- Moist towelettes
Technique
- Place the patient in the prone position, placing either a pillow or blankets under their hips for comfort and ideal positioning
- Using tape, separate the patient’s buttocks from one another to better visualize the perianal area
- Ensure that the perianal area is clean by removing debris with moist towelette
- Peripheral to the anal sphincter, choose multiple injection sites that allow for fanning circumferentially around the anus
- Advance 27G needle into one of these preselected areas
- Aspirate to rule out intravascular placement prior to injecting 3 -5 mL of anesthetic
- Continue to the other preselected areas, fanning the needle circumferentially in order to surround the anal area with local anesthetic