AHRQ WebM&M: Morbidity & Mortality Rounds on the Web
Residual Anesthesia: Tepid BurnCommentary by Matt M. Kurrek, MD, and Rebecca S. Twersky, MD, MPH
A 42-year-old Filipino man presented to an outpatient surgery center for scheduled repair of an anal fistula. The patient received pre-procedure anesthesia with a "saddle block" and underwent a successful intervention. When his anesthesia block began to wear off, he was deemed safe for discharge and instructed to take sitz baths with tepid water.
One month later, the patient returned for a second evaluation under anesthesia, and the surgeon noted scarring on the patient's buttocks and proximal posterior thighs. There were also large areas of healed burns and associated skin changes. Additional history from the patient and his wife indicated that they misunderstood the term "tepid" and used scalding hot water for the sitz baths. It also appears the patient's slowly resolving saddle anesthesia in the first 24 hours home blunted his response to the hot water. Unfortunately, the patient did not seek additional medical attention. It was felt that challenges with both health literacy and language barriers contributed to the patient's failed understanding of discharge instructions.