title: Local anesthesia for stapled prolapsectomy in day surgery: results of a prospective trial.
abstract: OBJECTIVE
  This article reports the results of a prospective trial of the feasibility of Longo's procedure under local anesthesia in day surgery.
  
  
  METHODS
  From April 2002 to May 2003, 66 patients (42 males and 24 females) were enrolled in the study; the mean age was 47.5 (range, 23-65) years. Thirty-six patients (55 percent) had prolapsed third-degree hemorrhoids, while 30 (45 percent) had fourth-degree hemorrhoids. All patients were operated on under local infiltration of the anorectal region by injecting ropivacaine 7.5 mg/dl using a Quadrijet. During the surgical procedure, blood pressure and heart rate were always monitored and the level of pain was checked using a visual analog scale. Hospital discharge was programmed for 6:00 p.m. Any immediate complications, such as bleeding, urinary retention, or pain, were also recorded.
  
  
  RESULTS
  It was possible to perform the procedure under local anesthesia in all patients, and the anesthesiologist did not need to intervene at any time. No vagal reaction was observed; the transient reduction of blood pressure and heart rate, which occurred in four patients (6 percent),was controlled with an analgesic drug. In 96 percent of the cases the mean intraoperative visual analog score was not higher than four. Fifty-six patients were discharged at 6:00 p.m., while only 10 percent required an overnight stay.
  
  
  CONCLUSIONS
  The stapled prolapsectomy procedure is feasible and can be performed safely under local anesthesia and as day surgery. This procedure provides good pain control and results in a minimal number of complications.
authors.affiliation: Department of General Surgery-UCP Seriate, Bolognini Hospital, Seriate, Bergamo, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Mariani
authors.forename: Gianluca
authors.initials: G
authors.lastname: Arrigoni
authors.forename: Giorgio
authors.initials: G
authors.lastname: Quartierini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dapri
authors.forename: Sara
authors.initials: S
authors.lastname: Leone
authors.forename: Matteo
authors.initials: M
authors.lastname: Barabino
authors.forename: Enrico
authors.initials: E
authors.lastname: Opocher
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D013537:Sutures; D016896:Treatment Outcome