Pudendal nerve block versus local anesthesia for harmonic scalpel hemorrhoidectomy: a prospective randomized study

Tepetes, Konstantinos; Symeonidis, Dimitrios; Christodoulidis, Gregory; Spyridakis, M.; Hatzitheofilou, Konstantinos

doi:10.1007/s10151-010-0614-z

Cited by 23 publications

(46 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The present study included various indications for proctological surgery, such as haemorrhoidectomy, fissurectomy and surgical correction of anal fistulas, whereas most earlier studies focused on a perianal block for pain management in patients undergoing haemorrhoidectomy. Kazemeini and colleagues specifically looked at perianal block in surgery for anal fistula.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Gabrielli and colleagues infiltrated the ischiorectal fossa on both sides by injection solely through the posterior commissure 2 cm from the anal verge. Several studies have described procedures that directly infiltrate the sphincter complex and/or the submucosal layer. Other studies reported the use of a pudendal block either using a nerve stimulator or anatomical landmarks such as the tuberosity of the ischium.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Rotigliano¹,

Füglistaler²,

Guenin³

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

Background The benefit of a perianal block as an adjunct to general or regional anaesthesia is debated. This RCT aimed to compare pain at 24 h and up to 14 days after proctological surgery in patients with and without a perianal block. Methods Between January 2018 and April 2019, patients were allocated to receive a perianal block with ropivacaine or placebo as an adjunct to anaesthesia. Patients, surgeons and assessors were blinded. The primary outcome was pain measured on a numerical rating scale (NRS) after 24 h. Secondary outcomes were need for rescue analgesia, and pain after 1, 2, 3, 6 and 12 h. The mean, rest and maximum NRS scores were measured for 14 days. Results A total of 138 patients were included, of whom 46 and 44 received general anaesthesia with or without ropivacaine respectively, and 23 and 25 received spinal anaesthesia with or without ropivacaine respectively (P = 0·858). The mean NRS score differed significantly at 24 h (mean(s.d.) 1·1(0·1) versus 2·3(0·2); P < 0·001), but not at 1 h (1·4(0·2) versus 2·2(0·3); P = 0·051). The NRS score was lower with use of ropivacaine at 2 h (1·0(0·2) versus 1·6(0·2); P = 0·045), 3 h (0·9(0·2) versus 1·5(0·2); P = 0·022), 6 h (1·1(0·2) versus 1·8(0·2); P = 0·042) and 12 h (1·2(0·2) versus 1·8(0·2); P = 0·034). The use of oral morphine equivalents was 10·2(1·4) and 16·6(2·5) mg with and without ropivacaine respectively (P = 0·028). The mean and maximum NRS scores within 14 days were lower when ropivacaine was used (95 per cent c.i. for difference 0·14 to 0·49 (P = 0·002) and 0·39 to 0·63 (P < 0·001) respectively). There was no injection‐associated morbidity. Conclusion Perianal block as an adjunct to general or regional anaesthesia should be recommended for proctological surgery. It yields a reduction in pain, a reduced need for opioids, and a faster recovery with minimal risk of adverse events. Registration number: NCT03405922 ( http://www.clinicaltrials.gov).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Rotigliano¹,

Füglistaler²,

Guenin³

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…The main anesthetic techniques that have been used so far for anorectal procedures are: spinal anesthesia and combined (venous and local) anesthesia 7 and, less frequently, general and epidural anesthesia [8][9][10] . Local anesthesia alone, despite producing interesting results presented in the literature [11][12][13] , has been increasingly questioned, as it brings more benefits to selected patients. The combined use of venous anesthesia with local infiltrations offers comfort to both patient and surgeon and prevents several complications associated with general and spinal anesthesia 14 .…”

Section: Methodsmentioning

confidence: 99%

Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

Kotze¹,

Junior²,

Freitas³

et al. 2011

J. Coloproctol. (Rio J.)

View full text Add to dashboard Cite

There is no consensus on the ideal anesthesia for hemorrhoidectomy in ambulatory facilities. Spinal anesthesia and venous propofol associated with local perianal block (combined anesthesia) are frequently used, and their direct costs may be crucial for the anesthesia type selection. The objective of this study was to compare the direct costs of anesthesia-related materials in hemorrhoidectomy between these two anesthetic techniques.Retrospective and cross-section analysis, comparing the direct costs of the materials of spinal and venous anesthesia with propofol associated with local perianal block, in hemorrhoidectomy. Twenty patients were included, ten submitted to each anesthesia type (five from each gender). The mean age in the spinal anesthesia group was 46.5 years and in the combined anesthesia group, 42.5 years (p=0.334). The mean cost of anesthesia-related materials was R$ 58.50 (R$ 36.48 - R$ 85.79) in the first group versus R$ 190.31 (R$ 98.16 - R$ 358.51) in the second - 69.27% difference between them (p<0.001). The mean costs according to gender analysis were R$ 50.32 and R$ 66.69 (p=0.263) in the spinal anesthesia group versus R$ 222.52 and R$ 158.10 (p=0.221) in the combined anesthesia group, respectively. The direct costs of anesthesia-related materials were significantly lower in patients submitted to hemorrhoidectomy using spinal anesthesia. No difference was observed between the genders in each group analyzed.
Não há consenso sobre a técnica anestésica de escolha para hemorroidectomias em regime ambulatorial. A raquianestesia e a anestesia combinada (venosa com propofol + local) são frequentemente utilizadas, e os custos das mesmas podem ser determinantes na escolha do melhor tipo de anestesia. O objetivo deste trabalho foi avaliar e comparar os custos diretos dos materiais anestésicos utilizados em hemorroidectomias entre essas duas técnicas. Foi feito um estudo retrospectivo e transversal, comparativo entre os custos diretos dos materiais anestésicos entre a raquianestesia e a anestesia venosa com poropofol associada ao bloqueio perianal local, em hemorroidectomias. Foram analisados 20 pacientes, 10 operados com cada técnica anestésica (5 de cada gênero). A média de idade do grupo da raquianestesia foi de 46,5 anos e do grupo da anestesia combinada foi de 42,5 anos (p=0,334). O custo médio do procedimento anestésico no primeiro grupo foi de R$ 58,50 (R$ 36,48 - R$ 85,79), no segundo foi de R$ 190,31 (R$ 98,16 - R$ 358,51). A diferença das médias foi de 69,27%, com significância estatística (p<0,001). A média dos custos dos gêneros masculino e feminino no grupo da raquianestesia foi de R$ 50,32 e R$ 66,69 (p=0,263) e no grupo da anestesia combinada foi de R$ 222,52 e R$ 158,10 (p=0,221), respectivamente. Os custos diretos médios dos materiais anestésicos dos pacientes submetidos a hemorroidectomias foram significativamente menores no grupo da raquianestesia. Não houve significância estatística na diferença entre os gêneros em cada grupo

show abstract

“…This surgical procedure can be conducted by means of local infiltration, [1][2][3][4][5] in association with sedation and/or general anesthesia with pudendal nerve block, 4,6,7 spinal block 5,6,8 or epidural block, 9,10 or with general anesthesia alone. 7 The choice of anesthesia depends on the characteristics of both the disease and the patient, as well as professional experience.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

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...

show abstract

Pudendal nerve block versus local anesthesia for harmonic scalpel hemorrhoidectomy: a prospective randomized study

Abstract: These data suggest that HSH performed under pudendal nerve block is a safe and efficient technique.

Cited by 23 publications

References 7 publications

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

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

Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

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

Contact Info

Product

Resources

About