Randomized clinical trial of stapled haemorrhoidopexy performed under local perianal block versus general anaesthesia

Abstract

Background:The aim was to assess the feasibility of performing stapled haemorrhoidopexy under local anaesthesia.Methods: Fifty-eight patients with haemorrhoid prolapse were randomized to receive local or general anaesthesia. The perianal block was applied immediately peripheral to the external sphincter. Submucosal block was added after applying the purse-string suture. Patients reported average and peak pain daily for 14 days using a visual analogue scale (VAS). They also completed anal symptom questionnaires before the operation and at follow-up. The surgeon assessed the restoration of the anal anatomy 3-6 months after surgery.Results: The anal block was sufficient in all patients. The mean accumulated VAS score for average pain was 23·1 in the general anaesthesia group and 29·4 in the local anaesthesia group (P = 0·376); mean peak pain scores were 42·1 and 47·9 respectively (P = 0·537). Mean change in symptom load was also similar between the groups, with score differences of 7·0 in the general anaesthesia group and 6·1 in the local anaesthesia group. No patient had a recurrence of prolapse. Conclusion:Perianal local block is easy to apply with a high degree of acceptability among patients. Postoperative pain, restoration of anatomy and symptom resolution were similar to that of stapled haemorrhoidopexy performed under general anaesthesia. Registration number: ISRCTN19930199 (http://www.controlled-trials.com).

The Effect of Local Injections of Bupivacaine Plus Ketamine, Bupivacaine Alone, and Placebo on Reducing Postoperative Anal Fistula Pain: A Randomized Clinical Trial

“…Level of postoperative pain according to VAS was between 1 and 4, which agreed with most of the other studies [ 4 , 5 , 17 , 18 ]. Mean pain level at all times was the lowest in group 3, followed by groups 2, 4, and 1, respectively.…”

“…Two pain reduction techniques in anorectal surgeries include local infiltration and block [ 9 , 14 , 15 ]. A variety of different choices of local anesthetics have been proposed, which include lidocaine [ 16 , 17 ], ropivacaine [ 4 , 18 , 19 ], or a combination of lidocaine and bupivacaine [ 1 , 5 , 8 , 17 , 20 ] with [ 1 , 5 , 8 , 17 , 20 , 21 ] or without adrenaline [ 4 , 16 , 18 , 19 ].…”

“…Both Jack knife [ 4 , 8 , 16 , 18 , 19 ] and lithotomy [ 5 , 17 ] positions have been proposed for anorectal surgeries. In the present study, lithotomy position was preferred, so that, in case of ineffective spinal anesthesia, general anesthesia could be applied without changing position, even though this was not required, and anesthesia was complete in every case, and no surgery had to be terminated, nor did local anesthesia change to general anesthesia in any patient, which concurs with other studies [ 22 – 24 ].…”

“…Although general anesthesia, spinal anesthesia, and nerve blocks [ 1 , 4 – 9 ] have been examined in anorectal surgeries, combined local and spinal anesthesia for greater patient comfort after anorectal surgery and pain control has been studied less.…”

Long‐term results of stapled haemorrhoidopexy in a prospective single centre study of 153 patients with 1–6 years’ follow‐up

“…There were no emergency procedures. More than 90% (140/153) of the patients were discharged the same day as surgery and local anaesthesia was used in just over half of them (57%) [14,15]. One hundred and three (67%) were Grade 3.…”