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

Abstract

Background and Aims:This study compared if perianal block using ropivacaine and dexmedetomidine was as good as spinal anesthesia (SA) using bupivacaine (heavy) for closed hemorrhoidectomies.Methods:A prospective randomized study was conducted in sixty patients who underwent closed hemorrhoidectomy. Thirty patients of Group A received SA. Thirty patients in Group B received local perianal block. Patients were evaluated for onset of the block, total pain-free period, and time to ambulation. Patient satisfaction in terms of pain during injection and satisfaction with the anesthesia technique was assessed after 2-week telephonically. Data were statistically analyzed using unpaired t-test for the continuous variables and Fischer's exact test for categorical variables.Results:Onset of anesthesia was significantly earlier in Group B, mean (standard deviation [SD]) value being 3.17 (1.28) min as compared to Group A, 6.24 (4.28) min (P = 0.0004). Total pain-free period (mean [SD]) in minute was longer in Group B, 287 (120) min as compared to Group A, 128 (38) min. Time to ambulation was significantly earlier in Group B, 22.83 (29.32) min as compared to Group A 302 (92.41) min. Pain during injection between the two groups was comparable. However, more patients in Group B (60%) were satisfied with the anesthesia technique as compared to Group A (27.5%).Conclusion:Perianal block for hemorrhoidectomy with ropivacaine 0.2% using dexmedetomidine as an adjuvant is an effective and reliable technique which is as effective as SA. It provides prolonged postoperative analgesia and early ambulation.

Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial

“…Various techniques, including conventional analgesics, local perianal anesthesia, and pudendal nerve block, have been successfully used to control pain caused by hemorrhoidectomy. [ 19 , 20 ] Even though these techniques can effectively provide analgesia during hemorrhoidectomy, they may have potential adverse effects. [ 21 ] Despite being a recently introduced technique, the utilization of ESPB has gained widespread recognition and has been applied for postoperative pain management across various surgical procedures.…”

The role of pudendal nerve block in hemorrhoid surgery: a systematic review and meta-analysis of double-blind randomized controlled trials

“…Tail or spinal anesthesia can also relieve pain, but the analgesic effect is short-lived, often accompanied with side effects, particularly urinary retention ( 29 ). Local infiltration can alleviate postoperative pain in patients undergoing hemorrhoid surgery, but this pain relief only lasts for 5–12 h ( 30 , 31 ). Further, improvement in their analgesic effects remains unsatisfactory.…”

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

“…The participants were allocated using envelope cancealment technique and their identification parameters were recorded while consenting to participate to the study. Intraoperatively, patients underwent open hemorrhoidectomy in lithotomy position, using a mixture of bupivacaine 0.5% at a maximum safe dose of 2 mg/kg with adrenaline (1:200,000) for local anesthesia group or 1.5 ml of 0.5% bupivacaine for saddle block group following the technique of Kavitha Jinjil [ 11 ]. Postoperatively, the occurrence of pain following open hemorrhoidectomy was determined in both groups using the Visual analogue Scale (VAS).…”