Preemptive analgesia with 0.75% ropivacaine causes significant reduction in pain perception, request for an analgesic and hospital stay. Therefore it is advisable before inguinal hernioplasty.

Background: Sacrococcygeal pilonidal sinus is a common condition usually affecting young-to-middle-aged men. For managing sacrococcygeal pilonidal illness, a variety of lateralizing surgical flap procedures based on this principle have been published, including the Karydakis flap, Limberg flap, modified Limberg flap, Z-plasty, and Y-V advancement flap. Aim: To compare the outcome of simple excision with primary closure versus rhomboid excision with limberg flap for sacrococcygeal pilonidal sinus. Methodology: Randomized control study conducted in Surgery Department, Ghurki Trust Hospital, Lahore. 90 patients fulfilling the inclusion criteria were selected from wards and were randomly divided in two equal groups. In group A, patients underwent rhomboid excision with limberg flap. In group B, patients underwent simple excision with primary closure. The operation was performed under spinal anesthesia. After surgery, patients were evaluated every 24 hours if they are able to move on their own then they were discharged and hospital stay was noted. Then after 10 days, patients will be called in OPD for assessment of wound healing. If wound did heal and patient complained of pain (VAS>4) and cannot sit and have fever (temp>100oF) Results: The average age in group A was 44.37±15.42 years while that in group B was 45.24±14.50 years. In group A there were 23(51.1%) males and 22 (48.9%) females whereas in group B there were 25(55.6%) males and 20(44.4%) females. There was difference significant in the mean stay in hospital in both groups (p-value=0.002). Conclusion: The conclusion of the study, that primary sacrococcygeal pilonidal sinus disease and rhomboid excision with Limberg's flap is an effective treatment. Keywords: Simple Excision with Primary Closure, Rhomboid Excision, Limberg Flap, Sacrococcygeal Pilonidal Sinus

Background: the study was conducted to analyze the efficacy of 0.75% ropicaine at perianal block for open haemrrhoidectomy with regards to pain intensity, first demand of analgesia and hospital stay. Method: 50 patients were selected for open haemrrhoidectomy under GA which were divided into two groups.it was a randomized control trial in which sealed envelope method was used for the group delegation in which Group A was designated to the patients having the perianal block with 0.75% ropivacaine while the group B was the placebo group having normal saline injected in the perianal region. The variables compared were the first demand of analgesia, pain intensity and the duration of the hospital stay. In order to make the site of injection more authentic the injections were sited under ultrasound guidance. Results: The pain intensity which was analyzed with the visual analogue score (VAS) had a median of 3.8 (high=6, low=3) in group A while 5.5 (high=8, low=4) in the Group B with the p value of < 0.05. The mean time recorded for the first demand of analgesia was 6.20 ± 1.20 hours in the Group A which had improved from 1.20 ± 1.0 hours in the Placebo Group while the p value was < 0.001, while the mean time of hospital stay got reduced from 22.5±3.30 hours to 12.4 ± 3.10 hours with the significant p value of < 0.002. Conclusion: It was observed that with preemptive analgesia with 0.75% ropivacaine administered led to a substantial reduction in pain perception, request for an analgesic and hospital stay. Therefore it is appropriate to administer it before open hemorrhoidectomy. Keywords: preemptive anaesthesia, local anesthesia, postoperative pain, ropivacaine, open hemorrhoidectomy