CT-Guided Inferior Rectal Nerve Block for Postoperative Pain Management After Hemorrhoidectomy

Hemorrhoidectomy is among the most painful procedures in colorectal surgery. Effective postoperative pain management remains an unmet clinical need. To evaluate the efficacy, duration of analgesia, and safety of CT-guided inferior rectal nerve block (IRNB) for postoperative pain management following hemorrhoidectomy.

This retrospective study enrolled 69 patients with grade III or IV mixed hemorrhoids undergoing hemorrhoidectomy between April 2024 and March 2026. Patients who elected to receive IRNB were assigned to Group 1 (n = 38); those who declined formed Group 2 (n = 31, standard analgesia). Group 1 received bilateral CT-guided IRNB on postoperative day 1 using a mixture of triamcinolone acetonide, 0.5% bupivacaine HCl, normal saline, and epinephrine. Pain intensity was assessed using the Numerical Rating Scale (NRS, 0-10) at baseline and on postoperative days 1 to 10, 14, and 28. Analgesic use and complications were also recorded.

Group 1 showed significantly lower median NRS scores than Group 2 on postoperative day 1 (2 [1-5] vs 5 [4-7]; P < .001), with sustained superiority through day 14 (1 [0-1] vs 2 [0-3]; P < .05). A secondary pain peak occurred in Group 1 on day 4 (4 [2-5]), consider pharmacological attrition and pain rebound. Both groups reached near-complete pain resolution by day 28. Complication rates did not differ significantly between groups.

CT-guided IRNB may provides effective and safe postoperative analgesia following hemorrhoidectomy, with significant pain control over the first 2 postoperative weeks.