How to do Open Hemorrhoidectomy Under Local Anesthesia and its Comparison with Spinal Anesthesia

Abstract

50 patients with III/IV degree hemorrhoids and grade II hemorrhoid not responding to conservative treatment were randomized to LA (5 grade II, 15 grade III and 5 grade IV) and SA (7 grade II, 14 grade III and 4 grade IV). Assessment was carried out afterwards in terms of pain scores (using Numerical Rating Scale, NRS at 30 mins, 90 mins, 6 h and 24 h) and post operative analgesia. Secondary outcomes were complications like urinary retention, post operative headache and surgical complications, and overall stay. Median pain scores were comparable in both the treatment groups during the whole study period except at 6 h where significantly higher (p < 0.05) pain scores were noted in spinal anesthesia group. Complications were much higher in Spinal anesthesia [Hypotension (4patients); post operative headache (6patients); urinary retention (9patients)]. Mean time at first bladder evacuation was significantly higher in patients operated under spinal anesthesia [8 h (SA) Vs 1.5 h (LA)]. Average hospital stay was significantly longer in patients operated under spinal anesthesia (p value < 0.001). Local anesthesia is an alternative mode of anesthesia that surgeon can safely carry out by their own. In our study hemorrhoidectomy under local anesthesia was associated with a shorter hospital stay, lower pain scores and lower post operative complications which supports the routine use of local anesthesia for hemorrhoidectomy.

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy

“…Postoperative analgesia was excellent in more than 90% of the participants who received local infiltration, but was excellent in less than 50% of the group that received a spinal block. 5 Another study did not find any differences in pain intensity between the local infiltration and spinal anesthesia groups at 6 and 24 h after surgery; however, the latter group required more analgesic rescue treatment. 12 In one study in which bupivacaine infiltration was performed in combination with general anesthesia, the analgesic effect lasted for approximately 10 h, 18 i.e.…”

“…5 Longer stays after spinal anesthesia for hemorrhoidectomy have been correlated with urine retention, pain and bleeding. 23 In this study, urinary retention occurred in 19% of SG.…”

“…This surgical procedure can be conducted by means of local infiltration, [1][2][3][4][5] in association with sedation and/or general anesthesia with pudendal nerve block, 4,6,7 spinal block 5,6,8 or epidural block, 9,10 or with general anesthesia alone. 7 The choice of anesthesia depends on the characteristics of both the disease and the patient, as well as professional experience.…”

Geleneksel diyatermi ile kıyaslandığında harmonik bistürinin hemoroidektomide faydası var mıdır?

“…In a meta-analysis about post hemorrhoidectomy pain relief, Joshi et al [12] found that local anesthetic injection, either as a sole technique or as an adjunct to general or regional anesthesia are recommended, therefore, long-acting local anesthetics are recommended for all patients undergoing hemorrhoidal surgery. In a prospective study by Bansal et al [26] comparing local anesthesia with bupivacain/xylocaine with spinal anesthesia, they found out that postoperative analgesia had very excellent removal of postoperative pain seen in more than 90 % of the patients operated on under local anesthesia, while it was achieved in less than 50% of the patients operated on under spinal anesthesia (p<0.05). Additionally, they found that certain postoperative complications such as urinary retention and postoperative headache were always seen in the spinal anesthesia group [26].…”

“…In a prospective study by Bansal et al [26] comparing local anesthesia with bupivacain/xylocaine with spinal anesthesia, they found out that postoperative analgesia had very excellent removal of postoperative pain seen in more than 90 % of the patients operated on under local anesthesia, while it was achieved in less than 50% of the patients operated on under spinal anesthesia (p<0.05). Additionally, they found that certain postoperative complications such as urinary retention and postoperative headache were always seen in the spinal anesthesia group [26].…”