Ischiorectal Block with Bupivacaine for Post Hemorrhoidectomy Pain

Rajabi, Mehdi; Hosseinpour, Mehrdad; Jalalvand, Faranak; Afshar, Mohammad; Moosavi, Sayed Mojtaba; Behdad, Samin

doi:10.3344/kjp.2012.25.2.89

Cited by 19 publications

(39 citation statements)

References 17 publications

(15 reference statements)

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“…Bupivacaine was used at the same concentrations and quantity as those of ropivacaine in the present study by Anannamcharoen et al . and Rajabi and co‐workers, and at different concentrations and quantity in two other studies. Kazemeini and colleagues found no difference in reduction of postoperative pain after anal fistula surgery under spinal anaesthesia between perianal infiltration of 1 ml ketamine plus 2 ml of 0·5 per cent bupivacaine and 1 ml saline solution plus 2 ml of 0·5 per cent bupivacaine.…”

Section: Discussionmentioning

confidence: 92%

“…Conversely, Jinjil and co‐workers used anterior and posterior injection sites in preference to the lateral sites. Rajabi et al . took the ischial tuberosity as a benchmark, and inserted a finger into the rectum to prevent the latter being punctured and to guide the needle.…”

Section: Discussionmentioning

confidence: 99%

“…The present study included various indications for proctological surgery, such as haemorrhoidectomy, fissurectomy and surgical correction of anal fistulas, whereas most earlier studies focused on a perianal block for pain management in patients undergoing haemorrhoidectomy. Kazemeini and colleagues specifically looked at perianal block in surgery for anal fistula.…”

Section: Discussionmentioning

confidence: 99%

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Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

Rotigliano¹,

Füglistaler²,

Guenin³

et al. 2020

British Journal of Surgery

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Background The benefit of a perianal block as an adjunct to general or regional anaesthesia is debated. This RCT aimed to compare pain at 24 h and up to 14 days after proctological surgery in patients with and without a perianal block. Methods Between January 2018 and April 2019, patients were allocated to receive a perianal block with ropivacaine or placebo as an adjunct to anaesthesia. Patients, surgeons and assessors were blinded. The primary outcome was pain measured on a numerical rating scale (NRS) after 24 h. Secondary outcomes were need for rescue analgesia, and pain after 1, 2, 3, 6 and 12 h. The mean, rest and maximum NRS scores were measured for 14 days. Results A total of 138 patients were included, of whom 46 and 44 received general anaesthesia with or without ropivacaine respectively, and 23 and 25 received spinal anaesthesia with or without ropivacaine respectively (P = 0·858). The mean NRS score differed significantly at 24 h (mean(s.d.) 1·1(0·1) versus 2·3(0·2); P < 0·001), but not at 1 h (1·4(0·2) versus 2·2(0·3); P = 0·051). The NRS score was lower with use of ropivacaine at 2 h (1·0(0·2) versus 1·6(0·2); P = 0·045), 3 h (0·9(0·2) versus 1·5(0·2); P = 0·022), 6 h (1·1(0·2) versus 1·8(0·2); P = 0·042) and 12 h (1·2(0·2) versus 1·8(0·2); P = 0·034). The use of oral morphine equivalents was 10·2(1·4) and 16·6(2·5) mg with and without ropivacaine respectively (P = 0·028). The mean and maximum NRS scores within 14 days were lower when ropivacaine was used (95 per cent c.i. for difference 0·14 to 0·49 (P = 0·002) and 0·39 to 0·63 (P < 0·001) respectively). There was no injection‐associated morbidity. Conclusion Perianal block as an adjunct to general or regional anaesthesia should be recommended for proctological surgery. It yields a reduction in pain, a reduced need for opioids, and a faster recovery with minimal risk of adverse events. Registration number: NCT03405922 ( http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

Rotigliano¹,

Füglistaler²,

Guenin³

et al. 2020

British Journal of Surgery

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“…There are many approaches and treatments for postoperative pain management after hemorrhoidectomy, including local treatments such as the use of nitrates, anion exchange resins (cholestyramine), complex aluminum sucrose sulfates (sucralfate), topical anesthetics, analgesics, and calcium channel blockers (such as nifedipine and diltiazem) (8,(14)(15)(16)(17)(18)(19)(20). Metronidazole was discovered in 1950 and synthesized in 1957.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial

Solorio-López

Ur²,

Je³

et al. 2015

Rev Esp Enferm Dig

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Introduction: Hemorrhoidal disease occurs in 50% of people aged > 40 years and is the most common reason for anorectal surgery. Pain is the main complication. Multiple topical and systemic drugs have been investigated for pain control, but there is no ideal treatment. Metronidazole has been shown to decrease postoperative pain but is not used widely.Objective: To evaluate the effect of oral metronidazole versus placebo and to assess postoperative pain following hemorrhoidectomy.Material and methods: Controlled clinical trial in adult patients who underwent elective hemorrhoidectomy for grade III/IV hemorrhoids. Patients were assigned to receive metronidazole (500 mg q8 h orally; study group, SG) or placebo (control group, CG) for 7 days after surgery. Pain was assessed using a visual analog scale after surgery. Analgesic administration (time and use of analgesics) and resumption of daily life activities were also assessed.Results: Forty-four patients were included, 22 in each group. Postoperative pain differed significantly between the SG and CG at 6 h

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“…A further local anesthetic strategy described in the literature is injection of local anesthetic into the ischiorectal fossa. One study compared ischiorectal fossa block with no block and placebo, demonstrating improved pain scores and reduced analgesic requirements in the block group (Rajabi et al 2012). Another randomized study compared ischiorectal fossa block plus local anesthetic wound infiltration, compared with wound infiltration alone (Luck and Hewett 2000).…”

Section: Local Anesthetic Nerve Blockmentioning

confidence: 99%

Literature Data on Perioperative Management After Surgery for Hemorrhoids

Emmett¹,

Mercer-Jones²

2017

Hemorrhoids

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Excisional hemorrhoidectomy is a commonly performed procedure for symptomatic hemorrhoids. This term encompasses both "open" (Milligan-Morgan) and "closed" (Ferguson) hemorrhoidectomy techniques, as well as excisional procedures performed using surgical devices such as Ligasure and harmonic scalpel. These procedures pose certain challenges in the perioperative period, especially in the management of postoperative pain, bowel function, and wound healing.

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Ischiorectal Block with Bupivacaine for Post Hemorrhoidectomy Pain

Cited by 19 publications

References 17 publications

Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial

Literature Data on Perioperative Management After Surgery for Hemorrhoids

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