Randomized clinical trial comparing day-care open haemorrhoidectomy under local versus general anaesthesia.
BACKGROUND
Day-care open haemorrhoidectomy under local anaesthesia (LH) may be the most cost-effective 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.


CONCLUSIONS
LH has similar tolerance and clinical outcome to GH, and is associated with a shorter journey time and lower cost.


BACKGROUND
NCT00503269 (http://www.clinicaltrials.gov).
Kushwaha
R
R
Channel Day Surgery Unit, William Harvey Hospital, Ashford TN24 0LZ, UK.
Hutchings
W
W
Davies
C
C
Rao
N G
NG
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods* / Q000523:psychology; D000768:Anesthesia, General / Q000379:methods* / Q000523:psychology; D000772:Anesthesia, Local / Q000379:methods* / Q000523:psychology; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D006484:Hemorrhoids / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome