Ambulatory hemorrhoidectomy

ABSTRACT

Hemorrhoidectomy is eligible for day case surgery, but the presences of postoperative pain and! or urinary retention interfere with this concept. This study aimed to use local anesthesia with posterior perineal block [PPB] technique to perform hemorrhoidectomy with comfort and to decrease the postoperative pain and urinary retention allowing early patient discharge. Sixty patients with 3rd or 4th degree hemorrhoids were randomized into two groups. The first group; 20 patients [15 men and 5 women, mean age 40.7 +/- 9.27] received general anesthesia [control group]. The second group; 40 patients [31 men and 9 women, mean age 42.4. +/- 8.83] received PPB with 50 ml ropivacaine 0.5%. Milligan - Morgan hemorrhoidectomy was then undertaken for all patients. There were no local or systemic toxicity for ropivacaine. In the PPB group, the intraoperative analgesia was adequate in 87.5% patients. The postoperative pain was assessed at 30 minute, 2, 4, 8, 12 and 24 hours using visual analog scale WAS]. At all time pain was less in the patients who had received PPB. The rate of urinary retention was 5% [2 patients] in PPB group while it reaches 25% [5 patients] in the control group. Thirty eight patients [95%] in the PPB group and 10 patients [50%] in the control group were discharged on the day of surgery. By the six postoperative weeks all hemorrhoidectomy wounds were healed. PPB technique is safe and provide adequate anesthesia to perform hemorrhoidectomy associated with decreased postoperative pain, urinary retention as well as postoperative analgesic requirements