Postoperative analgesia for haemorrhoidectomy. A comparison between caudal and local infiltration

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