Posterior perineal block with ropivacaine 0.75% for pain control during and after hemorrhoidectomy

Brunat, Georges; Pouzeratte, Y.; Mann, C.; Didelot, Jean-Michel; Rochon, Jean-Claude; Eledjam, Jean‐Jacques

doi:10.1053/rapm.2003.50132

Cited by 31 publications

(15 citation statements)

References 23 publications

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“…As in other studies, 13,14 we administered long-acting 0.75% ropivacaine, which is less toxic than bupivacaine. On the other hand, ropivacaine causes vasoconstriction, which limits its blood absorption.…”

Section: Discussionmentioning

confidence: 99%

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Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy

et al. 2017

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BACKGROUND AND OBJECTIVES: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications. DESIGN AND SETTING: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital. METHODS: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed. RESULTS: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention. CONCLUSIONS: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects. REGISTRATION: ClinicalTrials.gov NCT02839538. RESUMO CONTEXTO E OBJETIVO:A analgesia pós-operatória e a recuperação precoce são relevantes para a alta hospitalar. O objetivo primário deste estudo foi comparar a eficácia analgésica da infiltração perianal e da anestesia subaracnóidea para hemorroidectomia. O objetivo secundário foi comparar o tempo para alta, efeitos adversos e complicações. TIPO DE ESTUDO E LOCAL: Estudo randomizado prospectivo e comparativo, no Hospital Dr. Mário Gatti. MÉTODOS: Foram incluídos 40 pacientes com idades 18-60 anos, na categoria 1 ou 2 de status físico da Sociedade Americana de Anestesiologistas. O grupo local (GL) recebeu infiltração local (ropivacaína a 0,75%) sob anestesia geral; o espinal (GS) recebeu bloqueio subaracnóideo (2 ml de bupivacaína a 0,5%). A suplementação analgésica foi com fentanil para GL e lidocaína para GS. Foram avaliados: intensidade da dor no pós-operatório, relaxamento do esfíncter, força dos membros inferiores, tempo de alta, dose de analgésico em uma semana e efeitos adversos. RESULTADOS: Onze (52,4%) pacientes em GL necessitaram de complementação, e nenhum em GS. A intensidade da dor foi maior para GL até 120 minutos, sem diferenças em 150 ou 180 minutos. Não houve diferenças na necessidade de paracetamol ou tramadol. O tempo para a primeira complementação analgésica e a alta hospitalar foram maiores para GS. Os efeitos adversos foram náuse...

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Section: Discussionmentioning

confidence: 99%

“…40 ml for a 0.75% solution). 13,14 No consensus yet exists regarding the efficacy of local infiltration, the duration of its effect or the associated adverse effects and complications. Therefore, studies that assess both the analgesic and adverse effects are necessary.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy

et al. 2017

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“…Various methods to reduce postoperative pain in this procedure have included electrosurgical devices, such as diathermy, ultrasonic dissection, Ligasure Ò , and stapled hemorrhoidopexy [12], which diminish thermal injury to the subjacent tissue and reduce sphincter muscle [13], and the use of different forms of analgesia and anesthesia [14,15]. Numerous other attempts to control posthemorrhoidectomy pain have been reported, including the use of botulin toxin [16] and nitrates [17] to reduce internal sphincter spasm, metronidazole [18] to avoid bacterial fibrinolysis, or sucralfate [19] utilizing a mechanical barrier to favor wound epithelization or to improve pain control and patient comfort in the immediate postoperative course with infiltration of long-acting local anesthetic, pre-emptively or postoperatively [20,21].…”

Section: Discussionmentioning

confidence: 99%

Randomized placebo-controlled trial on local applications of opioids after hemorrhoidectomy

et al. 2009

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“…The local application medications [1][2][3] , administered on the muscle 4-7 or other site [8][9][10][11][12][13][14][15] , as well as the approved resources in the literature to treat or avoid pain [16][17][18] were not used for we wouldn´t have a variable that could interfere on the pain process.…”

Section: Discussionmentioning

confidence: 99%

“…Many surgical and anesthetic measures have been used to avoid or to lessen such. It is up to the anesthesiologist to adopt some measures recommending the use of certain medicaments [1][2][3][4][5][6][7][8][9][10] , preemptive analgesia [11][12][13][14][15] . Botulinic toxin injection can also be used in the internal sphincter 16 micronized fractions of flavonoids 17 and the transcutaneous electrical stimulation 18 .…”

Section: Introductionmentioning

confidence: 99%

Epidural anesthesia using a 0,75% ropivacaine and subarachnoid anesthesia with a 0,5% bupivacaine associated or not with clonidine in hemorroidectomies

Baptista

Paulo²,

Paulo³

et al. 2008

Acta Cir. Bras.

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PURPOSE: To study the safety and efficiency of two anesthetic blockages in hemorroidectomy and the effect of clonidine on analgesia. METHODS: 80 patients were studied, randomly divided into four groups: l (n=19)- peridural with a 0,75% ropivacaine; 2 (n=21)-peridural with a 0,75% ropivacaine and 150 µg of clonidine; 3 (n=19)- subarachnoid with a 0,5% bupivacaine; 4 (n=21)- subarachnoid with a 0,5% bupivacaine and 50 µg of clonidine. The intensity of pain was evaluated by the visual analogical scale 8, 12 and 24 hours after surgery. The use of vasoconstrictors on the transoperatory and the amount of analgesics within the 24 hours were registered. RESULTS: The intensity of pain, 8 hours after surgery, was lesser on group 4, and much lesser on group 4 comparing with groups 1 and 2, 12 hours (p=0,022; p=0,001) and 24 hours (p=0,03; p=0,003). The frequency of vasoconstrictors usage on the transoperatory and the analgesics on the post-operatory showed no difference among the groups. There were no anesthetic complications. CONCLUSIONS: The subarachnoid anesthesia with a 0,5% bupivacaine with clonidine, showed better analgesia comparing with the peridural anesthesia with a 0,75% ropivacaine with or without clonidine, however all were safe and efficient. The clonidine aided on the decreasing of pain when subarachnoid anesthesia was used.

show abstract

Posterior perineal block with ropivacaine 0.75% for pain control during and after hemorrhoidectomy

Cited by 31 publications

References 23 publications

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy

Randomized placebo-controlled trial on local applications of opioids after hemorrhoidectomy

Epidural anesthesia using a 0,75% ropivacaine and subarachnoid anesthesia with a 0,5% bupivacaine associated or not with clonidine in hemorroidectomies

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