Combination of Topical EMLA With Local Injection of Lidocaine: Superior Pain Relief After Ferguson Hemorrhoidectomy

Shiau, Jieh Min; Hung, King-Chü; Chen, Hong Hua; Chen, Wei Hao; Wu, Yuan-Hua; Tseng, Chia Chih

doi:10.1097/ajp.0b013e3180e00d31

Cited by 10 publications

(8 citation statements)

References 10 publications

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“…The present study included various indications for proctological surgery, such as haemorrhoidectomy, fissurectomy and surgical correction of anal fistulas, whereas most earlier studies focused on a perianal block for pain management in patients undergoing haemorrhoidectomy. Kazemeini and colleagues specifically looked at perianal block in surgery for anal fistula.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from Gerjy et al 8,21 and Park and colleagues 35 , who used the same concentration and amount of ropivacaine, all other authors who infiltrated with ropivacaine employed different concentrations and quantities 13,23,27 . Lidocaine was used in several studies 5,24,26,36 . Kushwaha and co-workers 12 reported a short period of effectiveness for a 30-ml solution of 1 per cent lidocaine with 1 : 10 000 adrenaline (epinephrine) and advised the use of a longer-acting local anaesthetic agent.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

Rotigliano¹,

Füglistaler²,

Guenin³

et al. 2020

British Journal of Surgery

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Background The benefit of a perianal block as an adjunct to general or regional anaesthesia is debated. This RCT aimed to compare pain at 24 h and up to 14 days after proctological surgery in patients with and without a perianal block. Methods Between January 2018 and April 2019, patients were allocated to receive a perianal block with ropivacaine or placebo as an adjunct to anaesthesia. Patients, surgeons and assessors were blinded. The primary outcome was pain measured on a numerical rating scale (NRS) after 24 h. Secondary outcomes were need for rescue analgesia, and pain after 1, 2, 3, 6 and 12 h. The mean, rest and maximum NRS scores were measured for 14 days. Results A total of 138 patients were included, of whom 46 and 44 received general anaesthesia with or without ropivacaine respectively, and 23 and 25 received spinal anaesthesia with or without ropivacaine respectively (P = 0·858). The mean NRS score differed significantly at 24 h (mean(s.d.) 1·1(0·1) versus 2·3(0·2); P < 0·001), but not at 1 h (1·4(0·2) versus 2·2(0·3); P = 0·051). The NRS score was lower with use of ropivacaine at 2 h (1·0(0·2) versus 1·6(0·2); P = 0·045), 3 h (0·9(0·2) versus 1·5(0·2); P = 0·022), 6 h (1·1(0·2) versus 1·8(0·2); P = 0·042) and 12 h (1·2(0·2) versus 1·8(0·2); P = 0·034). The use of oral morphine equivalents was 10·2(1·4) and 16·6(2·5) mg with and without ropivacaine respectively (P = 0·028). The mean and maximum NRS scores within 14 days were lower when ropivacaine was used (95 per cent c.i. for difference 0·14 to 0·49 (P = 0·002) and 0·39 to 0·63 (P < 0·001) respectively). There was no injection‐associated morbidity. Conclusion Perianal block as an adjunct to general or regional anaesthesia should be recommended for proctological surgery. It yields a reduction in pain, a reduced need for opioids, and a faster recovery with minimal risk of adverse events. Registration number: NCT03405922 ( http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

Rotigliano¹,

Füglistaler²,

Guenin³

et al. 2020

British Journal of Surgery

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“…Postoperative pain complaint is most frequently encountered especially subsequent to hemorrhoidectomy. Hence studies and development of technical procedures focus mostly on this postoperative complication [9][10][11] This complication frequently leads to delay in the intervention of the disease and definitely affects the choice of procedure to employ.…”

Section: Discussionmentioning

confidence: 99%

“…ÇİFTÇİ, T. ANUK disease and in fact, could be responsible for the anal pain during the postoperative period following hemorrhoid surgery. There are reports that internal anal sphincter spasm has a significant effect on the development of post-operative early complications that include pain, urine retention and anal stenosis 10,16 . Another report showed that topical diltiazem treatment alleviated the pain in a series 10 .…”

mentioning

confidence: 99%

Hemoroidlerin Cerrahi Tedavisinde Ferguson Hemoroidektomi

Çiftçi

Anuk

2022

İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi

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Amaç: Prolabe hemoroidal hastalık nedeniyle ameliyat edilen hastalarımızın ameliyatında geleneksel Ferguson yaklaşımının sonucunu değerlendirmek amaçlanmıştır.Yöntem: Mart 2007-Ocak 2017 tarihleri arasında Ferguson tekniği ile tedavi edilen 769 hasta çalışmaya dahil edildi. Hastaların tıbbi dosyaları değerlendirilerek başvuru şikayetleri, anorektal komorbiditeler, ameliyat bulguları ve postoperatif erken ve geç komplikasyon verileri kaydedildi.Bulgular: Hastaların% 65'i erkekti ve ortalama yaş 39 (18-81) idi. Şikayet süreleri bir hafta ile 5 yıl arasında değişiyordu. Şikayetler sık görülenden az görülene doğru sırasıyla ele gelen pake, kanama ve ağrı idi. Paker'l2r, hastaların %69'unda klasik konumdaydı (saat 3,5,7,11). Vakaların çoğu (% 65) 4. derece hemoroiddi. Hastaların%19'unda anorektal komorbidite olarak anal fissür vardı. Tüm hastalar litotomi pozisyonunda spinal anestezi altında ameliyat edildi. Ferguson tekniği için ameliyat süresi ortalama 20 dakika ve ameliyat sonrası hastanede kalış süresi ortalama bir gündü. Postoperatif dönemde 55 hastada erken komplikasyonlar gelişti. Bunlar 25 hastada (%3-25) şiddetli karın ağrısı, 3 hastada (% 0.4) kanama ve 28 hastada (% 3.60) idrar retansiyonu idi. Yedi hastada geç komplikasyonlar gelişti. 1 hastada anal stenoz, 3 hastada anal fissür ve 2 hastada apse ile fistül gelişti. Hiçbir hastada inkontinans ve nüks görülmedi.Sonuç: Ferguson tekniği halen hemoroid cerrahisinde kullanılmaktadır. Çalışmamızın sonuçları, güvenilir bir tercih yöntemi olarak Ferguson hemoroidektomisini desteklemektedir.

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“…For example, lidocaine and prilocaine (EMLA, AstraZeneca, Wilmington, DE) ointment can provide supplemental pain relief and spare narcotic use over placebo even when local anesthetics are injected intraoperatively. 44 Spasm of the internal anal sphincter after hemorrhoidectomy has been suggested to be a contributory factor in pain and to be an inhibitor of healing, and so topical agents used for anal fissures have also been suggested for use in postoperative pain. A meta-analysis of hemorrhoidectomy supported the use of glyceryl trinitrate (GTN) ointment for improving pain control for 3 to 7 days after surgery with improved healing, although the side effect of headache was a limiting factor.…”

Section: Topical Agentsmentioning

confidence: 99%

Perioperative Management of the Ambulatory Anorectal Surgery Patient

Shaw

Ternent

2016

Clinics in Colon and Rectal Surgery

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Ambulatory surgery is appropriate for most anorectal pathology. Ambulatory anorectal surgery can be performed at reduced cost compared with inpatient procedures with excellent safety, improved efficiency, and high levels of patient satisfaction. Several perioperative strategies are employed to control pain and avoid urinary retention, including the use of a multimodal pain regimen and restriction of intravenous fluids. Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions.

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Combination of Topical EMLA With Local Injection of Lidocaine: Superior Pain Relief After Ferguson Hemorrhoidectomy

Cited by 10 publications

References 10 publications

Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

Hemoroidlerin Cerrahi Tedavisinde Ferguson Hemoroidektomi

Perioperative Management of the Ambulatory Anorectal Surgery Patient

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