Abstract
Background and Objectives. Several anesthesia techniques were applied to hemorrhoidectomy, but postoperative pain and urinary retention were still two unsolved problems. The aim of this prospective randomized study was to evaluate the effect of ultrasound-guided pudendal nerve block (PNB) combined with deep sedation compared to spinal anesthesia for hemorrhoidectomy. Methods. One hundred and twenty patients undergoing Milligan–Morgan hemorrhoidectomy were randomized to receive PNB combined with deep sedation using propofol (Group PNB, n = 60) or spinal anesthesia (Group SA, n = 60). Pain intensity was assessed using the visual analogue scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on walking at 12, 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, and patient satisfaction after surgery. Results. Ultrasound-guided bilateral PNB combined with deep sedation using propofol could successfully be applied to Milligan–Morgan hemorrhoidectomy. Postoperative pain intensity was significantly lower in Group PNB compared to Group SA at rest at 3, 6, 12, 24, 36, and 48 h (p < 0.001) and during mobilization at 12, 24, 36, and 48 h (p < 0.001) postoperatively. Sufentanil consumption in Group PNB was significantly lower than that in Group SA, during 0–24 h (p < 0.001) and during 24–48 h (p < 0.001) postoperatively. Urinary retention was significantly lower in Group PNB compared to Group SA (6.9% vs 20%, p=0.034). The patients in Group PNB had higher satisfaction compared to Group SA (p < 0.001). Conclusions. Ultrasound-guided PNB combined with propofol sedation is an effective anesthesia technique for Milligan–Morgan hemorrhoidectomy.
Highlights
Hemorrhoidal disease prevails in all mankind ages
Is study aimed to investigate whether pudendal nerve block (PNB) combined with deep sedation using propofol could be successfully applied to Milligan–Morgan hemorrhoidectomy and decrease postoperative pain and the incidence of urinary retention compared to spinal anesthesia
In this randomized controlled study, we demonstrated that ultrasound-guided bilateral PNB combined with deep sedation using propofol can successfully be applied to Milligan–Morgan hemorrhoidectomy. is anesthesia technique provided the same anal sphincter relaxation and surgical condition for surgeons as spinal anesthesia using 0.5% ropivacaine
Summary
Hemorrhoidal disease prevails in all mankind ages. Hemorrhoidectomy is one of the best methods to cure serious hemorrhoidal disease, providing a good quality of life [1]. Spinal anesthesia combined with pudendal nerve block (PNB) has been performed for hemorrhoidectomy and it could decrease postoperative pain. E ideal anesthesia technique for hemorrhoidectomy should provide relatively prolonged pain relief without increasing postoperative urinary retention and provide competent anal sphincter muscle relaxation. Previous studies reported that PNB can provide excellent postoperative analgesia for hemorrhoids surgery [5, 9, 11,12,13,14]. E PNB was recommended for all patients undergoing hemorrhoidal surgery by PROSPECT (PROcedure-SPECific postoperative pain managemenT) Working Group [15]. Is study aimed to investigate whether PNB combined with deep sedation using propofol could be successfully applied to Milligan–Morgan hemorrhoidectomy and decrease postoperative pain and the incidence of urinary retention compared to spinal anesthesia. A randomization list assigning subjects to either Group “A” or “B” was created without revealing the identity of the groups. e statistical analysis was completed, and conclusions were drawn before it was revealed which group received spinal anesthesia and which received PNB
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