Thailand. Local Perianal Nerve Block Versus Spinal Block for Closed Hemorrhoidectomy: A Ramdomized Controlled Trial

Objective: To compare analgesic effectiveness, postoperative pain, complications, and patients ’ satisfaction between two randomly allocated groups- one group that had local perianal nerve block and another group that had spinal block following closed hemorrhoidectomy. Material and Method: Sixty-seven patients underwent elective hemorrhoidectomy. Of these, 33 were randomly allocated to receive spinal anesthesia (SA) while 34 received perianal local analgesia (LA) with bupivacaine. Pain measurement at 6 and 24 hours following hemorrhoidectomy, the quantity of postoperative analgesic medication administered, patient’s satisfaction and complications were recorded. Results: Among the patients who had SA, there were 5 patients (15.2%) who developed hypotension during surgery. There was no reported case of hypotension among those who had LA. There was no significant difference in degree of median postoperative pain at 6 hours (LA: 38 vs. SA: 50 with VAS; p = 0.09) and at 24 hours (LA: 31 vs. SA: 35 with VAS; p = 0.35) between the two groups. Patients had a high satisfaction on both anesthetic methods. Patients in the SA group required more parenteral analgesics (p = 0.03) and had a higher incidence of urinary retention than those in the LA group (SA: 30.3 % vs. LA: 8.8%, p = 0.03). Conclusion: Local perianal nerve block for hemorrhoidectomy is feasible and safe and superior to spinal block due to a lower incidence of post-op urinary retention and less requirement of parenteral analgesics post-op