Local Perianal Block in Anal Surgery: The Disadvantage of Pain during Injection despite High Patient Satisfaction

Abstract

Purpose:We evaluated the usefulness of anal surgery using local perianal block and assessed patient satisfaction. Methods: From January to October 2008, a total of 41 consecutive patients consented to anal operation with local perianal block for stapled hemorrhoidopexy (n=15), excisional hemorrhoidectomy (n=9), fistulotomy (n=13), or abscess drainage (n=4). Postoperative pain was evaluated on a visual analogue scale (VAS) from 0 to 10. Patient satisfaction was evaluated through telephone interviews. Results:The mean peak VAS scores on the day of operation were 3.3 after stapled hemorrhoidopexy, 2.9 after excisional hemorrhoidectomy, 2.6 after fistulotomy, and 3.5 after abscess drainage; on postoperative day 1, the scores were 1.3, 1, 0.9, and 2.3, respectively. The majority of patients (31; 86.1%) were satisfied with the postoperative results (very satisfied 12, satisfied 19, only fair 5, unsatisfied 0). More than half of the patients (23; 63.9%) were satisfied with the use of local anesthesia (very satisfied 4, satisfied 19, only fair 12, unsatisfied 1). The mean VAS scores during injection were significantly different between the satisfied group (very satisfied and satisfied) and not-satisfied group (only fair and unsatisfied) treated with the local anesthesia (satisfied group: 3.5 and not-satisfied group: 5.4, P=0.04). Most patients (30; 83.3%) would undergo this anesthetic procedure again if future anal surgeries were necessary. Conclusion: Local perianal block is feasible for various anal operations and results in a high degree of satisfaction among patients. However, the pain associated with injection has an adverse effect on patient satisfaction. (J Korean Surg Soc 2010;78:106-110)

Comparison of local anaesthesia versus spinal anaesthesia for peri anal disorders

“…Most series reported visual analogue scale score <4 in anal surgery performed under local anaesthesia and were observed in many studies [13,14,15]. However in our study mean VAS was 4.…”

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

“…Perianal block was performed with the patient in a lithotomy position, and the intention was to infiltrate the perisphincteric region by needle insertion laterally on both sides of the anal verge. This technique is similar to that described by Nyström and colleagues and used by others, but avoided injection anteriorly through the perineum and posteriorly through the anococcygeal ligament. Conversely, Jinjil and co‐workers used anterior and posterior injection sites in preference to the lateral sites.…”

“…Infiltration of local anaesthetic into the highly sensitive anal region may cause pain and discomfort to the patient. Although the feasibility and safety of anal surgery under perianal block alone have been widely demonstrated, perianal infiltration has mostly been performed under sedation and/or with intravenous anaesthetics, whereas some researchers have proposed using a topical ointment before injection of local anaesthetics, with contrasting results.…”

Perianal block: Is it as good as spinal anesthesia for closed hemorrhoidectomies?

“…There have been studies which have compared perianal blocks with SA or GA.[ 9 10 ] They have all mentioned that local perianal block is feasible for hemorrhoidectomy with adequate postoperative pain relief, however, pain associated with injection is a major limiting factor preventing the use of perianal block as a sole anesthetic technique. [ 6 ]…”

“…[ 5 ] However, it is still not widely accepted by patients maybe due to pain on injection. [ 6 ] There is also hesitation on the part of the surgeons regarding the adequacy of relaxation under the block.…”