Impact of spinal versus general anesthesia on postoperative pain and long term recurrence after surgery for pilonidal disease.

Study Objective: To assess the effect of the kind of anesthesia on postoperative pain and long term recurrence rate in pilonidal sinus disease.

Design: Retrospective study.

Setting: Surgical departments of German Armed Forces Hospitals in Hamburg, Bad Zwischenahn and Hamm.

Patients: 583 pilonidal sinus disease (PSD) surgery patients operated for pilonidal disease.

Intervention: Interview of randomly selected patients, who had been followed up to 20years after PSD surgery.

Measurements: Analysis of long term recurrence-free survival and postoperative pain scores among patients who received different anesthesia modalities.

Main Results: Recurrence occurred in 21.97% of patients who received general anesthesia with intubation (ITN), in 23.32% of spinal anesthesia (SPA), and in 31.91% of local- or cryoanesthesia. Our data indicate that there was no significant difference in recurrence-free time between the types of anesthesia in any of the surgical procedures applied. Pain scores of patients who underwent primary midline closure (4.74±2.63, 95% CI [4.36, 5.12]) were significantly lower than pain scores of patients who underwent marsupialization (6.12±2.71, 95% CI [5.17, 7.07]) or primary open treatment (6.09±2.79, 95% CI [5.79, 6.39]) (P<.0001). Post-operative pain scores did not differ between patients who received ITN or SPA. Cryo- or local anesthesia resulted in significantly lower post-operative pain scores compared to ITN (P=.0089) or SPA (P=.0031).

Conclusion: The use of SPA or general anesthesia did not affect the long term recurrence rate in PSD. Postoperative pain experienced either in-hospital or after discharge did not differ between patients receiving ITN or SPA. With other cryo- or local anesthesia, postoperative pain score was significantly reduced in any surgical procedure. However, due to the higher recurrence rate after cryo- or local anesthesia, only SPA and general anesthesia should be applied. The decision whether spinal or general anesthesia is applied in PSD surgery remains a purely anesthesiological decision based on standard considerations.