RT Journal
A1 Ravin M, Salvati E, Plotkin R
T1 LOcal anesthesia technique for anorectal surgery
JF JAMA
JO JAMA
YR 1969
FD March 3
VO 207
IS 9
SP 1719
OP 1719
DO 10.1001/jama.1969.03150220135034
UL http://dx.doi.org/10.1001/jama.1969.03150220135034
AB To the Editor:— 
    The purpose of this letter is to publicize a simple technique of local anesthesia for anorectal surgery which evolved from that of Schneider1 and Salvati and Kratzer.2Patients are premedicated with an individualized dose of intramuscularly administered meperidine and atropine. The anesthetic solution is prepared by adding 2 ampules of hyaluronidase to 50 cc of 0.5% lidocaine with 1:200,000 epinephrine. The patient is placed in the prone jack-knife position and the perianal area is thoroughly cleaned. Extremely obese patients or those in whom an airway problem is anticipated are placed in lithotomy position. An intravenous infusion is then started and 2 cc of a solution containing 2 cc of a droperidol and fentanyl citrate mixture (Innovar) and 8 cc of saline is administered into the intravenous tubing. The remaining Innovar solution is administered intermittently during procedure, directly into the intravenous tubing.Perianal infiltration is begun