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


CONCLUSIONS
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.


BACKGROUND
ISRCTN19930199 (http://www.controlled-trials.com).
Colorectal Surgery, Department of Surgery, Linköping University Hospital, Linköping, Sweden. roger.gerjy@lio.se
R
R
Gerjy
A
A
Lindhoff-Larson
R
R
Sjödahl
P-O
PO
Nyström
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000294:innervation / Q000601:surgery; D000768:Anesthesia, General / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D011446:Prospective Studies; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome