Clinical Study The Effect of Local Injections of Bupivacaine Plus Ketamine, Bupivacaine Alone, and Placebo on Reducing Postoperative Anal Fistula Pain: A Randomized Clinical Trial Alireza Kazemeini, 1 Mojgan Rahimi, 2 Mohammad Sadegh Fazeli, 2 Seyedeh Adeleh Mirjafari, 3 Hamid Ghaderi, 4 Kamal Fani, 5 Mohammad Forozeshfard, 6 and Marzieh Matin 3 1 Department of General Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2 Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 3 Brain and Spinal Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran 4 Department of Cardiovascular Surgery, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 5 Department of Anesthesiology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 6 Department of Anesthesiology, Semnan Medical University, Semnan, Iran Correspondence should be addressed to Seyedeh Adeleh Mirjafari; adeleh 60@yahoo.com Received 10 October 2014; Accepted 13 November 2014; Published 3 December 2014 Academic Editor: Mellar P. Davis Copyright © 2014 Alireza Kazemeini et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background and Objective. his study aimed to compare the efects of diferent local anesthetic solutions on postoperative pain of anal surgery in adult patients. Method. In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old) with physical status class I and class II that had been brought to a university hospital operating room for istula anal surgery with spinal anesthesia were selected. Patients were randomly divided into 4 equal groups according to table of random numbers (created by Random Allocation Sotware 1). Group 1 received 3 mL of normal saline, group 2, 1 mL of normal saline plus 2 mL of bupivacaine 0.5%, group 3, 1 mL of ketamine plus 2 mL of bupivacaine 0.5%, and group 4, no iniltration. Intensity of pain in patients was measured using visual analogue scale (VAS) at 0 (transfer to ward), 2, 6, 12, and 24 hours ater surgery. Time interval to administration of drugs and overall dose of drugs were measured in 4 groups. Results. Mean level of pain was the lowest in group 3 at all occasions with a signiicant diference, followed by groups 2, 4, and lastly 1 ( < 0.001). Furthermore, groups 2 and 3 compared to groups 1 and 4 had the least overall dose of analgesics and requested them the latest, with a signiicant diference ( < 0.05). Conclusion. Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5%) combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients. 1. Introduction Anorectal diseases afect nearly 5% of the adult population [1]. Anal istula is a common anorectal problem and complaint of more than 10% of visits to anorectal clinics [2]. Fistula surgery can be performed under general, spinal, or local anesthesia [3]. Anal surgery is usually performed as inpatient, and the main reason for this is the concern about lack of postoperative pain control and associated problems [2]. Today, various medications have been studied for postoperative analgesia as suppositories, local anesthesia, or oral preparations. Yet the search for a suitable combination still continues. Although general anesthesia, spinal anesthesia, and nerve blocks [1, 4–9] have been examined in anorectal surgeries, combined local and spinal anesthesia for greater patient comfort ater anorectal surgery and pain control has been studied less. No comparison has yet been carried out on analgesic efect of local injection of bupivacaine or bupivacaine plus Hindawi Publishing Corporation e Scientific World Journal Volume 2014, Article ID 424152, 6 pages http://dx.doi.org/10.1155/2014/424152