Obtain informed consent
Place the patient in the prone position, placing either a pillow or blankets under their hips for comfort and ideal positioning
Using tape, separate the patient's buttocks from one another to better visualize the<unk>  area
Draw up anesthetic into 20 cc syringe using 18 Gauge Needle
Ensure that the<unk>  area is clean by removing debris with moist towelette
Peripheral to the anal sphincter, choose multiple injection sites that allow for fanning circumferentially around the anus
Advance 27 Gauge needle into one of these preselected areas
Aspirate to rule out intravascular placement prior to injecting 3 -5 mL of anesthetic
Continue to the other preselected areas, fanning the needle circumferentially in order to surround the anal area with local anesthetic
Perianal block
Suprapubic catheter changing or replacement
Suprapubic catheter placement
External hemorrhoid excision
Whole bowel irrigation
Suprapubic bladder aspiration
Bladder lavage
Escharotomy