Local perianal nerve block versus spinal block for closed hemorrhoidectomy: a ramdomized controlled trial.
OBJECTIVE
To compare analgesic effectiveness, postoperative pain, complications, and patients' satisfaction between two randomly allocated groups--one group that had local perianal nerve block and another group that had spinal block following closed hemorrhoidectomy.


METHODS
Sixty-seven patients underwent elective hemorrhoidectomy. Of these, 33 were randomly allocated to receive spinal anesthesia (SA) while 34 received perianal local analgesia (LA) with bupivacaine. Pain measurement at 6 and 24 hours following hemorrhoidectomy, the quantity of postoperative analgesic medication administered, patient's satisfaction and complications were recorded.


RESULTS
Among the patients who had SA, there were 5 patients (15.2%) who developed hypotension during surgery. There was no reported case of hypotension among those who had LA. There was no significant difference in degree of median postoperative pain at 6 hours (LA: 38 vs. SA: 50 with VAS; p = 0.09) and at 24 hours (LA: 31 vs. SA: 35 with VAS; p = 0.35) between the two groups. Patients had a high satisfaction on both anesthetic methods. Patients in the SA group required more parenteral analgesics (p = 0.03) and had a higher incidence of urinary retention than those in the LA group (SA: 30.3% vs. LA: 8.8%, p = 0.03).


CONCLUSIONS
Local perianal nerve block for hemorrhoidectomy is feasible and safe and superior to spinal block due to a lower incidence of post-op urinary retention and less requirement of parenteral analgesics post-op.
Anannamcharoen
Sahaphol
S
Department of Surgery, Phramongkutklao Hospital, Bangkok 10400, Thailand.
Cheeranont
Piyapan
P
Boonya-usadon
Chinnakrit
C
D000328:Adult; D001003:Anal Canal / Q000187:drug effects* / Q000294:innervation / Q000601:surgery; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007263:Infusions, Parenteral; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy
D000779:Anesthetics, Local; D002045:Bupivacaine