Hemorrhoidectomy with posterior perineal block - Experience with 400 cases

PURPOSE: The aim of this study was to evaluate the advantages and feasibili ty of hemorrhoidectomy using regional anesthesia (posterior perineal block) . METHODS: From March 1994 to December 1998 we performed 400 hemorrhoidecto mies with regional anesthesia in an overnight-stay regimen in our departmen t (Colo-Rectal Unit). Posterior perineal block involves anesthesia of the d eep plains (infiltration of the inferior hemorrhoidal nerves, the posterior branch of the internal pudendal nerves, and the anococcygeal nerves) and a nesthesia of the superficial plains (block of the inferior gluteal nerves a nd of perineal branches of minor nerves from the sacral plexus). RESULTS: P osterior perineal block was always effective; optimal to satisfactory intra operative analgesia was obtained in 379 patients (95.2 percent), whereas in 17 cases (4.2 percent) intravenous analgesic drugs were administered. No c onversion to general anesthesia was needed. Urinary retention was 7.8 perce nt. In our study most of patients (70 percent) reported no pain at all for five to ten hours. Ninety-two percent of patients were discharged in the fi rst 24 hours. CONCLUSIONS: Posterior perineal block allows the surgeon to p erform radical hemorrhoidectomies in an overnight-stay regimen with safe an d effective intraoperative and postoperative analgesia, sphincter relaxatio n, and low incidence of urinary retention. Experience of the surgeon combin ed with careful surgical handling are of great importance for success in th is technique.