Local Perianal Block versus Spinal anesthesia for Closed hemorrhoidectomy

Abstract

Objective: To compare analgesic effectiveness, postoperative pain and complication following closed hemorrhoidectomy under local perianal block and spinal anesthesia.

Material and Method: A prospective non-randomized study of fifty-seven consecutive patients who underwent closed hemorrhoidectomy during May 2002 and August 2003. Twenty-nine patients received perianal local anesthesia (LA) and the other 28 were under spinal anesthesia (SA). Outcome measures were mean pain scores at 6, 24 hours and day 14 and 28 following hemorrhoidectomy, analgesic requirements and postoperative complications. Comparison was made between the two groups.

Results: There was no significant difference in degree of mean postoperative pain at 6 hours (LA: 4.34 VS SA: 5.25; p = 0.07), 24 hours (LA: 3.28 VS SA: 4.00; p = 0.11), day 14 (LA: 1.45 VS SA: 1.54; p = 0.61) and day 28 (LA: 0.47 VS SA: 0.44; p = 0.52) between the two groups. Postoperative analgesic requirements were comparable in the two groups; analgesic pills (p = 0.65) and parenteral analgesics (p = 0.25). Bleeding complication and wound dehiscence were similar in the two groups, however LA groups had a lower incidence of urinary retention than those in SA group (LA: 3.4% VS SA: 28.6%; p < 0.05).

Conclusion: Local perianal block for hemorrhoidectomy is effective and safe and feasible. It has a lower incidence of post-op urinary retention. This is an easy technique and should be an alternative approach in the treatment of hemorrhoidal disease.