Randomized clinical trial comparing day-care open haemorrhoidectomy under local <i>versus</i> general anaesthesia

Kushwaha, R.; Hutchings, W.; Davies, C. K.; Rao, Naveen

doi:10.1002/bjs.6113

Cited by 43 publications

(65 citation statements)

References 60 publications

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“…Hemorrhoidectomy can be performed under general anesthesia; however, there may be the complications resulting from general anesthesia together with associated diseases in advanced age. Caudal or spinal anesthesia has been used as an alternative to general anesthesia for hemorrhoid surgery, but they all require a trained anesthetist and have numerous known complications [2].…”

Section: Discussionmentioning

confidence: 99%

How to do Open Hemorrhoidectomy Under Local Anesthesia and its Comparison with Spinal Anesthesia

et al. 2012

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50 patients with III/IV degree hemorrhoids and grade II hemorrhoid not responding to conservative treatment were randomized to LA (5 grade II, 15 grade III and 5 grade IV) and SA (7 grade II, 14 grade III and 4 grade IV). Assessment was carried out afterwards in terms of pain scores (using Numerical Rating Scale, NRS at 30 mins, 90 mins, 6 h and 24 h) and post operative analgesia. Secondary outcomes were complications like urinary retention, post operative headache and surgical complications, and overall stay. Median pain scores were comparable in both the treatment groups during the whole study period except at 6 h where significantly higher (p < 0.05) pain scores were noted in spinal anesthesia group. Complications were much higher in Spinal anesthesia [Hypotension (4patients); post operative headache (6patients); urinary retention (9patients)]. Mean time at first bladder evacuation was significantly higher in patients operated under spinal anesthesia [8 h (SA) Vs 1.5 h (LA)]. Average hospital stay was significantly longer in patients operated under spinal anesthesia (p value < 0.001). Local anesthesia is an alternative mode of anesthesia that surgeon can safely carry out by their own. In our study hemorrhoidectomy under local anesthesia was associated with a shorter hospital stay, lower pain scores and lower post operative complications which supports the routine use of local anesthesia for hemorrhoidectomy.

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Section: Discussionmentioning

confidence: 99%

How to do Open Hemorrhoidectomy Under Local Anesthesia and its Comparison with Spinal Anesthesia

et al. 2012

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“…However, this and the previous study showed that local block did not ameliorate pain on subsequent days or enhance recovery. Nevertheless, an alternative anaesthetic method allows patients a choice26. Stapled haemorrhoidopexy under perianal local anaesthetic block is effective, convenient and acceptable to most patients compared with the same procedure under general anaesthesia, providing a similar clinical result.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of stapled haemorrhoidopexy performed under local perianal block versus general anaesthesia

Gerjy

Lindhoff-Larson

Sjödahl

et al. 2008

British Journal of Surgery

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Background:The aim was to assess the feasibility of performing stapled haemorrhoidopexy under local anaesthesia.Methods: Fifty-eight patients with haemorrhoid prolapse were randomized to receive local or general anaesthesia. The perianal block was applied immediately peripheral to the external sphincter. Submucosal block was added after applying the purse-string suture. Patients reported average and peak pain daily for 14 days using a visual analogue scale (VAS). They also completed anal symptom questionnaires before the operation and at follow-up. The surgeon assessed the restoration of the anal anatomy 3-6 months after surgery.Results: The anal block was sufficient in all patients. The mean accumulated VAS score for average pain was 23·1 in the general anaesthesia group and 29·4 in the local anaesthesia group (P = 0·376); mean peak pain scores were 42·1 and 47·9 respectively (P = 0·537). Mean change in symptom load was also similar between the groups, with score differences of 7·0 in the general anaesthesia group and 6·1 in the local anaesthesia group. No patient had a recurrence of prolapse. Conclusion:Perianal local block is easy to apply with a high degree of acceptability among patients. Postoperative pain, restoration of anatomy and symptom resolution were similar to that of stapled haemorrhoidopexy performed under general anaesthesia. Registration number: ISRCTN19930199 (http://www.controlled-trials.com).

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“…Besides general, local and epidural anaesthesia, spinal anaesthesia is a common method for minor perianal procedures [2][3][4] . 'Saddle block' describes spinal anaesthesia with a low dose of hyperbaric local anaesthetics where the parts of a patient's body that would touch a saddle are anaesthetized.…”

Section: Introductionmentioning

confidence: 99%

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Schmittner¹,

Janke²,

Limmer³

et al. 2009

Med Princ Pract

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Objectives: Additional intra-operative sedation may help improve acceptability and comfort of anaesthesia in patients undergoing minor anorectal (perianal) procedures under spinal saddle block. This observational study was done to determine which patients request sedatives and to what extent sedatives affect the patients’ recovery. Subjects and Methods: During a 6-month period, 500 patients undergoing minor perianal procedures received 1.0 ml hyperbaric bupivacaine (0.5%). On request, a light sedation with propofol in bolus application was provided. Patients were evaluated postoperatively using a standardized questionnaire about their perceptions before, during and 48 h after the administration of anaesthesia. Results: More female (91/143, 63.6%) than male (136/259, 52.5%) patients (p = 0.0312) received sedation. Patients with sedation were significantly younger (46.7 ± 13.8 vs. 50 ± 13.8 years, p = 0.0171) and had a lower body mass index (BMI; 25.6 ± 4.3 vs. 27.5 ± 5.1, p < 0.0001). Time to mobilization and first micturition was significantly longer in patients with sedation (4.8 vs. 4.4 h, p = 0.0194 and 5.8 vs. 5.4 h, p = 0.0188), which was associated with a higher incidence of nausea (7.5 vs. 1.7%, p = 0.0083). Conclusions: Female gender, younger age, lower body weight and lower BMI were associated with higher subjective requirements for sedation. The use of sedation showed prolongation of time to first mobilization and micturition and a higher incidence of nausea.

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

Cited by 43 publications

References 60 publications

How to do Open Hemorrhoidectomy Under Local Anesthesia and its Comparison with Spinal Anesthesia

How to do Open Hemorrhoidectomy Under Local Anesthesia and its Comparison with Spinal Anesthesia

Randomized clinical trial of stapled haemorrhoidopexy performed under local perianal block versus general anaesthesia

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

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