Ischiorectal fossa block decreases posthemorrhoidectomy pain - Randomized,prospective, double-blind clinical trial

PURPOSE: Hemorrhoidectomy can be associated with severe pain in the immedia te postoperative period. The aim of this study was to assess the efficacy o f a preemptive local anesthetic, ischiorectal fossa block, in the reduction of pain and analgesic requirements after hemorrhoidectomy. METHODS: ALL pa tients were suitable for an established day surgery hemorrhoidectomy protoc ol, immediately before surgery patients were randomly assigned either to re ceive (Group 1) or not receive (Group 2) the local anesthetic block. All ot her aspects of surgery and anesthesia were standardized. Nursing staff asse ssed pain at 30 minutes and 2, 4, and 24 hours postoperatively using a visu al analog scale (1-10, where 1 represented no pain and 10 represented the w orst pain imaginable). Analgesic requirements also were recorded at these t imes. Both the patients and the nursing staff were blinded to which local a nesthetic protocol had been used. RESULTS: Twenty patients were enrolled in the trial. Ten patients were randomly assigned to Group 1 and ten to Group 2. Mean pain scores for Group 1 (anal block) at 0.5, 2, 4, and 24 hours we re 1.5, 1.8, 2.1, and 2.5, respectively, compared with Group 2, with mean p ain scores of 3.4, 3.4, 3.9, and 5.1. These differences were statistically significant. Patients in Group 1 used less analgesia in the first 24 hours postoperatively than those in Group 2. CONCLUSION: The use of a preemptive local anesthetic, ischiorectal fossa block, is associated with a significan t decrease in pain and analgesia requirements after hemorrhoidectomy.