ABSTRACT
In this research, we studied the effect of continuous perfusion of the anal canal with the long acting local anesthetic bupivacaine as well as a modified technique of closed hemorrhoidectomy, on post-operative pain. The modification used here is closure of the wounds in a circumferential direction rather than the classic radial manner. This work included 112 patients with 2nd., 3rd and 4th degrees hemorrhoids. They were divided randomly into 4 equal groups; [A1] open hemorrhoidectomy with continuous perfusion of anal canal with 500cc. Normal saline for 8-10 hours, [control group] [A2] like [A1] with the addition of 20cc. Bupivacine 0.5% to the saline. [B1] modified closed technique + perfusion with 500cc saline, [B2] like [B1] with the addition of bupivacaine to the saline. Post-operative pain was evaluated according to the demand for analgesia during the first postoperative day and also the first week. Continuous bupivacaine perfusion reduced significantly the need for analgesia during the first day; as shown in group A1 vs. A2 and also B1 vs. B2 [P<0.01]. Urine retention which is caused mainly by post-operative pain, was lower in the groups with bupivacaine perfusion [A2] and B2] but the difference was significant only between [B2] and [A1] [P<0.05]. During the first post-opeative week, patients managed by closed techniaue [B1] and B2] experienced lesser pain than the open group [A1 and A2] [P<0.001]. Comparing also the closed versus the open hemorrhoidectomy regarding wound healing and anal stenosis revealed, better results, with the former procedure through the first post-operative month [P<0.05]. From this study we recommend the use of continuous perfusion of the anal canal with bupivacaine and the use of closed technique for hemorrhoidectomy as this will decrease the post-operative pain and urine retention, and also the wounds will heal faster with lower tendency for anal stenosis