Background:Day-care open haemorrhoidectomy under local anaesthesia (LH) may be the most costeffective approach to haemorrhoidectomy. This prospective randomized trial compared outcome after LH from patients' and clinical perspectives with that after day-care open haemorrhoidectomy under general anaesthesia (GH).Methods: Forty-one patients with third-degree haemorrhoids were randomized to LH (19) or GH (22). Patient demographics were comparable. A single haemorrhoid was excised in 15 patients, and two and three haemorrhoids in 13 each. Independent nurse-led assessment and clinical evaluation were carried out for 6 months. Outcome measures were mean and expected pain scores at 30, 60 and 90 min, then daily for 10 days, and satisfaction scores at 10 days, 6 weeks and 6 months. Secondary outcomes were journey time within the day-surgery unit and overall cost.Results: Pain was worse following LH than GH at 90 min after surgery (P = 0·028), but pain scores on reaching home were similar. Maximum pain was experienced on day 3 after LH and on day 6 after GH. From day 1 onwards, daily pain scores were lower in the LH group, and there was a significant difference on day 8 (mean (95 per cent confidence interval) 3·61 (2·74 to 4·48) for LH versus 5·29 (4·12 to 6·45) for GH; P = 0·027). Mean pain over 10 days, expectation and satisfaction scores were similar in the two groups. LH had a shorter journey time and was less expensive than GH.Conclusion: LH has similar tolerance and clinical outcome to GH, and is associated with a shorter journey time and lower cost. Registration number: NCT00503269 (http://www.clinicaltrials.gov).

Endovenous laser treatment (EVLT) is a novel technique that is fast gaining acceptance as an alternative to open surgery for the treatment of long saphenous vein incompetence. In our experience, the use of cold saline infiltration (CSI) prior to laser occlusion is a safe alternative to local anaesthetic infiltration (LAI), avoiding the risks associated with local anaesthetic toxicity. CSI does not affect the immediate outcome of EVLT and allows the use of LAI to be reserved for additional open phlebectomies if required.

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BACKGROUND AND AIMS Aim of this study was to compare the changes in heart rate, blood pressure, oxygen saturation and cost effectiveness between general anaesthesia and spinal anaesthesia in pediatric patients undergoing lower abdominal and lower limb surgeries for the same duration. MATERIAL AND METHODS Fifty ASA1 patients in age group 0-5 years of either sex undergoing lower abdominal and lower limb surgeries were randomly divided in to two groups (Group-I GA group-n25 and Group-II SA group-n25). Group1 was given general anaesthesia and group-II was given spinal anaesthesia. Haemodynamic parameters and side effects during intra operative and immediate postoperative period were recorded and cost of GA and SA was calculated. RESULTS Patients in both the groups were comparable in surgical procedures and duration of surgery. Haemodynamically children in spinal group (Group-II) remained more stable intra operatively and no untoward incidence was observed in group-II. Spinal Anaesthesia was much more cost effective as compared to general anaesthesia. CONCLUSION Pediatric spinal anaesthesia is a safe and effective anaesthetic technique for lower abdominal and lower limb surgeries. It is much more cost effective as compared to general anaesthesia.