Cleft-lift operation for pilonidal sinuses under tumescent local anesthesia: a prospective cohort study of peri- and postoperative pain.

Bertelsen, Claus Anders

BACKGROUND The use of tumescent local anesthesia in the Bascom cleft-lift procedure has not been described before. OBJECTIVE This study aimed to find whether moderate to complex pilonidal sinuses could be treated using the cleft-lift procedure with local anesthesia, with only minor postoperative pain and brief sick leave. DESIGN This is a prospective cohort study. SETTING The study was conducted in a day-surgical department. PATIENTS Eighty-three consecutive cleft-lift operations for pilonidal sinus were performed with tumescent local anesthesia. INTERVENTIONS Tumescent local anesthesia with a saline water solution of 0.8 mg/mL mepivacaine and 0.001 mg/mL adrenalin buffered with sodium bicarbonate to pH 7.2 was infused subcutaneously. Seventy-five patients were interviewed daily by phone for 1 week to register their ability to return to work and to score their pain on a Numerical Rating Scale pain score from 0 (no pain) to 10. MAIN OUTCOME MEASURES Outcome measures were the rate of conversion to general anesthesia, peri- and postoperative pain, and the times to discharge and to return to work. RESULTS Eighty-two (99%) of the 83 procedures were performed with local anesthesia. In one patient, local was converted to general anesthesia. The mean maximum pain score experienced during the infusion was 3.7 (CI: 3.3-4.1), and during surgery, the score was 1.9 (CI: 1.4-2.3). Sixty-three (76%) of the patients were discharged directly from the operating room and 90% in less than an hour after the last stitch. The maximum pain after 2 days was none or mild (pain score ≤3) in 80% of the patients. Work could be resumed the next day by 35%, and after 4 days by 87% of the patients with a mean time of 3.0 (CI: 2.2-3.7) days. LIMITATIONS This study might be limited by its noncomparative design. CONCLUSION Most patients with moderate to complex pilonidal sinuses can be treated under local anesthesia without notable pain, and discharged minutes after the operation. The Bascom cleft-lift procedure causes only mild postoperative pain, and patients can resume work a few days later.