Postoperative Analgesia for Hemorrhoidectomy. A Comparison Between Caudal and Local Infiltration

Abstract

This study compared the analgesic eflectiseness of local injiltration of bupivacaine with caudal extradural bupivacaine in thejirst 48 hours ufter haemorrhoidectomy. Surgical and anaesthetic protocol was rigidly standardised. The caudal group had significantly less pain in the Jirst 6 hours after haemorrhoidectomy. and on jirst bowel opening, when compared to those who received local infiltration of bupivacaine. There was no signi$cant difference between the two groups with respect to further analgesic requirements, complications, time to first bowel action, and duration of hospital stay. The de5nite advantage of caudal extradural bupivacaine.for haemorrhoidectomy must be balanced against the rare but potentially serious complications associated with its use.

Evidence-based management of pain after haemorrhoidectomy surgery

“…Another study26 compared caudal epidural bupivacaine versus local wound infiltration with bupivacaine after induction of general anaesthesia. Pain scores were significantly lower with the caudal epidural group compared with the local infiltration group on awakening and at 3 h (both P < 0·05), at 6 h ( P < 0·01) and at first bowel action ( P < 0·05), but not at 12, 24 and 48 h or on pack removal.…”

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.…”

“…A further evolution in technique is day‐care open haemorrhoidectomy under local anaesthesia (LH). Although this has been reported previously6–11, there is a paucity of randomized controlled trials to support its routine use.…”

Topical Metronidazole can Reduce Pain after Surgery and Pain on Defecation in Postoperative Hemorrhoidectomy

“…[1][2][3][4][5] In prior studies, local anesthetics (bupivacaine), antiinflammatory drugs (NSAIDs), and nitrates (glyceryl trinitrate, 0.2%) have been evaluated for reducing pain after a hemorrhoidectomy. [6][7][8][9][10] These studies indicated some limitations with these medications such as short duration of action and serious side effects. Metronidazole, especially in topical form, has been more effective in reducing pain.…”