The use of local anesthesia and sedation in transanal hemorrhoidal dearterialization with Doppler

Abstract

The treatment of hemorrhoidal disease has never been as innovated as in recent decades. The transanal hemorrhoidal dearterialization with Doppler (THD) was described under general anesthesia or spinal blockage and there is no use of local anesthesia reports. This study aims to evaluate the safety of the use of local anesthesia with sedation in THD. For this purpose, two cases are reported describing the technical and safety analysis and results. Both patients were women with grade II and III hemorrhoidal disease. These patients underwent pre-anesthetic sedation with intravenous diazepam, then were positioned in lithotomy and sedated with midazolam and pethidine. The intersphincteric blockage was followed by THD with mucopexy. One patient made a small submucosal hematoma without expansion. The patients were stable and comfortable throughout the procedure. Both were discharged the next day, with regular analgesia. In the seventh postoperative day, both had mild annoyance at constant tenesmus, which was reduced gradually. The cases illustrate that THD is feasible when performed with local anesthesia and sedation, as it is safe and effective. This new technology can be incorporated into services that have a local anesthesia protocol as their standard.

Pain assessment following open hemorrhoidectomy under local anesthesia versus saddle block: a multicenter randomized controlled trial

“…Anorectal surgery requires adequate anesthesia due to its multiple nerve supply [ 9 ]. Painful stimuli can be blocked either with regional or general anesthesia (GA), usually with muscle relaxants [ 8 ]. Different studies have suggested that switching from GA or regional anesthesia like saddle block and or spinal anesthesia to local infiltration or perianal block (PAB) may prove advantageous for proctologic surgeries [ 17 ].…”

“…Controversial results have been published before as to the occurrence of pain following open hemorrhoidectomy under local anesthesia versus spinal anesthesia or general anesthesia. In the United Kingdom and in Brazil, studies found a similar mean pain scores in 10 days follow-up [ 8 , 13 ] yet in India and in Egypt, the mean rate of pain was seen to be lower post open hemorrhoidectomy under local anesthesia (LA) compared to that done under SA [ 1 , 2 , 19 ].…”

Open hemorrhoidectomy under local anesthesia versus saddle block in western Uganda: a study protocol for a prospective equivalence randomized, double-blind controlled trial

“…Local anesthesia (LA) is adequate for the majority of anal surgical procedures [ 8 ]. LA produces sensory and motor blockade in the peri-anal region with an effect on peripheral nerve endings and therefore produces varying and unpredictable degrees of anal canal relaxation [ 8 ].…”

“…Local anesthesia (LA) is adequate for the majority of anal surgical procedures [ 8 ]. LA produces sensory and motor blockade in the peri-anal region with an effect on peripheral nerve endings and therefore produces varying and unpredictable degrees of anal canal relaxation [ 8 ]. Operative time has been shown to be different according to the anesthetic technique used in terms of time saved during operation according to studies done by Kushwaha and Baghel with their colleagues comparing the use of LA versus spine and GA for open hemorrhoidectomy [ 2 , 9 ].…”

“…These complications increase the duration of hospital stay and morbidity [ 13 ]. The few numbers of anesthetic providers in developing countries like Uganda (0.05 per 100,000 population compared to 17.85 per 100,000 in the UK [ 14 ]) have been seen as a hindrance to access and performance of open hemorrhoidectomy especially at low-level facilities despite open hemorrhoidectomy being a very common surgical procedure [ 8 ]. The costs of anesthetic procedures have become an important factor in the selection of the best technique for benign anal surgeries [ 10 ].…”