{
  "abstract": "Background and Aims Spinal anaesthesia (SA) is an effective anaesthetic choice for perineal surgeries, which is typically performed with the patient seated or in lateral decubitus. For anorectal surgeries, patients need to be repositioned after SA, which can be technically challenging, lead to unpredictable spread of the local anaesthetic, and time-consuming. Therefore, performing SA with the patient already in prone position may be advantageous.Methods We present a case series of six patients who underwent stapled hemorrhoidopexy under SA already performed in prone position. Following preoperative evaluation, the patients positioned themselves in a comfortable prone position with rolls under the pelvis, chest and abdomen to facilitate lumbar spine flexion. After light sedation, SA was performed with a 27G Sprotte needle in L4-L5 or L5-S1 interspace. Gentle aspiration was usually needed to ensure reflux of cerebrospinal fluid. Levobupivacaine 6,5–7,5 mg and Sufentanyl 2 mcg were administered.Results SA was performed without any complications in all the patients, requiring a maximum of two attempts. After evaluating the effectiveness of the saddle block, the surgery took around 30–45 minutes. Patients remained comfortable and hemodynamically stable. Intravenous Acetaminophen 1 g and Ketorolac 30 mg were administered for analgesia. All cases were performed as outpatient procedures with discharge under 24 hours.Conclusions SA in the prone position remains an underutilized technique. This approach could offer optimal surgical exposure, while eliminating the need for additional mobilization, reducing haemodynamic and respiratory instability. The use of levobupivacaine allowed for reduced cephalad spread, lowering the risk of high SA compared to hyperbaric solutions.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal"
      ],
      "name": "Beatriz Xavier"
    },
    {
      "affiliations": [
        "Anesthesiology, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal"
      ],
      "name": "Susana Maia"
    },
    {
      "affiliations": [
        "Anesthesiology, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal"
      ],
      "name": "Ana Rita Rocha"
    },
    {
      "affiliations": [
        "Anesthesiology, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal"
      ],
      "name": "Cristina Sousa"
    },
    {
      "affiliations": [
        "Anesthesiology, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal"
      ],
      "name": "Joana Barros"
    },
    {
      "affiliations": [
        "Anesthesiology, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal"
      ],
      "name": "Rita Correia Conde"
    },
    {
      "affiliations": [
        "Anesthesiology, Hospital da Luz de Setúbal, Setúbal, Portugal"
      ],
      "name": "José Miguel Cardoso"
    }
  ],
  "title": "P021 Hemorrhoidopexy: why not perform spinal anesthesia in the prone position?",
  "uid": "0d9bcf1a-7b04-5774-a503-2e4bc35410e1"
}