Posterior Perineal Block with Ropivacaine 0.75% for Pain Control During and After Hemorrhoidectomy

Evidence-based management of pain after haemorrhoidectomy surgery

“…Posterior perineal block with ropivacaine was superior to control (no injection) in reducing postoperative pain scores ( P = 0·001), need for supplemental analgesia ( P < 0·001) and length of recovery room stay ( P < 0·001), but duration of hospital stay and time to first bowel movement were comparable ( Table S1 , supporting information)72.…”

“…The size of the circles indicates the sample size of the studies. Brunat et al 72, 24 h, P = 0·001; Chester et al 56, day 1, P not significant; Luck and Hewett13, 24 h, P = 0·002 (small circle); Morisaki et al 24, day 1, P < 0·05; Marsh et al 14, day 1, P < 0·05; Naja et al 12, 24 h, P < 0·005 (larger circle); Naja et al 25, 24 h, P < 0·001; Vinson‐Bonnet et al 71, 24 h, P not significant…”

Randomized clinical trial comparing day-care open haemorrhoidectomy under local versus general anaesthesia

“…Haemorrhoidectomy involves surgery on the sensitive anoderm, which is rich in nerve endings. Over the years, several possible ways of reducing pain and discomfort after this day‐care operation have been proposed, including use of multimodal analgesia5, 14–31, reducing postoperative anal spasm32–34, restricting surgery to one haemorrhoid at a time35, avoiding a closed technique36, use of bulky adherent dressings37, rectal application of metronidazole38, pre‐emptive analgesia3, 17, 39–43, diathermy dissection44, 45, caudal block8, 46, preoperative lactulose47, pudendal40, 48 and perineal11, 41, 42, 49, 50 blocks, stapled anopexy1, 51–63, Doppler‐guided haemorrhoid artery ligation64–74 and detailed counselling with a line of communication to the hospital5. Some of these are of doubtful value on their own48, 75, 76.…”

Effects of Aloe vera Cream on Posthemorrhoidectomy Pain and Wound Healing: Results of a Randomized, Blind, Placebo-Control Study

“…6 With regard to the effect of pain on discomfort of patients, several pharmacological agents were assessed for relieving pain in patients, including diltiazem ointment, 8 lidocaine and prilocaine creams, 9 sucralfate cream, 10 glyceryl trinitrite ointment, 11 and ropivacaine. 12 Recently we showed that patients who applied topical metronidazole had significantly lesser postoperative pain than those in the placebo group up to day 14. 13 Some studies have shown that reduced postoperative spasm of the internal anal sphincter is effective in reducing pain associated with sphincter spasm.…”