Comparison of Postoperative Results after Hemorrhoidectomy Using Local and Spinal Anesthesia

Hemorrhoidectomy is a common procedure in clinical practice. Most operations are performed on an inpatient basis using general or regional anesthesia, and the use of local anesthesia is still limited due to concerns about postoperative care.

To compare perioperative results including pain, urinary retention, bleeding and other complications after hemorrhoidectomy performed using local anesthesia (LA) on an out-patient basis with those achieved after spinal anesthesia (SA) on in-patient cases.

This was a retrospective study of closed hemorrhoidectomy of grade 3 hemorrhoids performed under local and spinal anesthesia between March 2011 and March 2014 in the Department of Surgery, Rajavithi Hospital, Bangkok.

A total of 91 patients with third-degree internal hemorrhoids were recruited. The subjects were divided into two groups with 50 patients in the LA group and 41 in the SA one. Early complications were similar in the two groups: patients in the LA group had more postoperative pain with visual analog (VAS) scores at 6 hours postoperatively of 8.8±1.26 compared with 5.3±1.09 (p<0.001) in the SA group, but at 24 hours postoperatively the LA patients had less pain with mean VAS scores of 6.5±1.25 compared with 7.29±1.15 (p = 0.002) in the SA group.

Hemorrhoidectomy under local anesthesia, with proper counseling and consent, is safe and feasible for use on an outpatient basis.