Perianal blockage with 0.5% bupivacaine for postoperative pain relief in hemorrhoidectomy

Abstract

Hemorrhoidectomy can be done in many positions under many anesthetic techniques as an ambulatory surgery. Post-procedural pain is frequently severe enough to delay home discharge. A combination between preincisional local anesthetics and general anesthesia looks attractive in terms of preemptive analgesia and starting time of surgery. The study aimed to compare anesthetic time, pain-free period and pain relief in patients with and without 0.5% plain bupivacaine infiltration after mask inhalation, total intravenous anesthesia or endotracheal tube general anesthesia. Material and Method: 142 patients were randomized into control(C) and study(S) groups with n = 70 and 72 respectively. Patient characteristics in both groups were : age 40.45 ± 13.03 VS 37.48 ± 13.63 years old, BW 59.77 ± 11.19 VS 58.80 ± 9.76 kg, male : female 31/39 VS 43/29, PS 1/2/3/E = 48/19/1/2 VS 53/15/3/1 for C and S respectively. All underwent surgery in lithotomy under ET/TIVA/mask : 53/13/4 VS 22/27/23 and anesthetic time was 49.02 ± 18.04 VS 33.33 ± 10.31 min (p < 0.05). Results: Pain-free periods in C and S were 204.44 ± 878.07 and 540 ± 298.03 min with median times of 57.5 (n = 67) VS 560 (n = 58) min. Pain severity in S was mainly none or mild degree while in C it was moderate or severe, apparently when analysed in subgroups of ET and TIVA. Analgesic requirements were statistically more in group C. Conclusion: Better postoperative pain relief could be accomplished by preincisional 0.5% plain bupivacaine infiltration after general anesthesia. The technique helped relax anal muscles for surgical ease and avoided patient discomfort in case of a prolonged procedure. Preemptive analgesia and key pain management were discussed.