by | Aug 23, 2021


  • Rectal foreign body removal
  • External hemorrhoid excision
  • Rectal prolapse
  • Anorectal abscess drainage


  • Infection overlying injection site
  • Allergy to local anesthetic


  • 15-20cc of local anesthetic of choice
  • 27G needle
  • Cleansing solution
  • Silk tape
  • Pillow or blankets
  • Moist towelettes


  1. Place the patient in the prone position, placing either a pillow or blankets under their hips for comfort and ideal positioning
  2. Using tape, separate the patient’s buttocks from one another to better visualize the perianal area
  3. Ensure that the perianal area is clean by removing debris with moist towelette
  4. Peripheral to the anal sphincter, choose multiple injection sites that allow for fanning circumferentially around the anus
  5. Advance 27G needle into one of these preselected areas
  6. Aspirate to rule out intravascular placement prior to injecting 3 -5 mL of anesthetic
  7. Continue to the other preselected areas, fanning the needle circumferentially in order to surround the anal area with local anesthetic


  1. WikEM