Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy

Luis Antônio Borges, Plínio da Cunha Leal, Ed Carlos Rey Moura, Rioko Kimiko Sakata, Luis Antônio Borges, Plínio da Cunha Leal, Ed Carlos Rey Moura, Rioko Kimiko Sakata

Abstract

Background and objectives:: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications.

Design and setting:: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital.

Methods:: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed.

Results:: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention.

Conclusions:: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects.

Registration:: ClinicalTrials.gov NCT02839538.

Conflict of interest statement

Conflicts of interest: None

Figures

Figure 1.. Consort flow diagram.
Figure 1.. Consort flow diagram.
Table 1.. Sociodemographic and clinical characteristics of…
Table 1.. Sociodemographic and clinical characteristics of participants, according to age, gender, weight, body mass index and ASA physical status
Table 2.. Intensity of pain at each…
Table 2.. Intensity of pain at each 30 minutes, according to numerical scale (mean ± standard deviation)
Table 3.. Time that elapsed until first…
Table 3.. Time that elapsed until first postoperative supplementation (after infiltration or spinal block), expressed as mean (minimum-maximum); doses of acetaminophen (mean ± standard deviation, SD); and doses of tramadol (mg) expressed as mean (minimum-maximum)

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