Perianal Blockage with 0.5% Bupivacaine for Postoperative Pain Relief in Hemorrhoidectomy
Siriwan Jirasiritham MD*, Kamthorn Tantivitayatan MD*, Sopon Jirasiritham MD**
Affiliation : * Department of Anesthesiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University ** Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University
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.
Materials and Methods : 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).
Results : 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.
Conclusion : 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.
Keywords : Anal surgery, Hemorrhoid, Local anesthetic, Preemptive analgesia
