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

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.

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).

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.

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.