Korean J Pain.  2012 Apr;25(2):89-93. 10.3344/kjp.2012.25.2.89.

Ischiorectal Block with Bupivacaine for Post Hemorrhoidectomy Pain

• Rajabi M
• Hosseinpour M
• Jalalvand
• Afshar M
• Moosavi G
• Behdad S

• KMID: 1778991
• DOI: http://doi.org/10.3344/kjp.2012.25.2.89

Abstract

BACKGROUND
Hemorrhoid is one of the most common surgical diseases occurring in the anorectal region. In this study, we evaluated the effect of ischiorectal fossa block on alleviating post hemorrhoidectomy pain.
METHODS
In this study, 90 patients suffering from hemorrhoids were evaluated. They were randomly divided into 3 groups. The first group had no block, the second group an ischiorectal block with placebo (normal saline), and the third group a preemptive ischiorectal block with bupivacaine. Postoperative variables such as pain intensity, pethidine consumption, nausea, and vomiting were compared between the groups.
RESULTS
The postoperative pain score in group 1 was 8.5 +/- 1.3 and 8.1 +/- 0.9 (P = NS) in group 2. The post operative analgesic demand was 3.1 +/- 1.5 and 3.3 +/- 1.8 hours in groups 1 and 2, respectively (P = NS). The post operative pain score and analgesic demand were 4.2 +/- 2.1 and 9.3 +/- 2.7 hours, respectively, in group 3 (P < 0.0001).
CONCLUSIONS
Preemptive ischiorectal block reduces the posthemorrhoidectomy pain and opioid demand.

Keyword

bupivacaine; hemorrhoidectomy; ischiorectal block

MeSH Terms

Bupivacaine
Hemorrhoidectomy
Hemorrhoids
Humans
Meperidine
Nausea
Pain, Postoperative
Stress, Psychological
Vomiting
Bupivacaine
Meperidine

Reference

1. Mukhashavria GA, Qarabaki MA. Circumferential excisional hemorrhoidectomy for extensive acute thrombosis: a 14-year experience. Dis Colon Rectum. 2011; 54:1162–1169. PMID: 21825898.

2. Greco DP, Miotti G, Della Volpe A, Magistro C, De Carli S, Pugliese R. Stapled hemorrhoidopexy: day surgery or one day surgery? Surg Oncol. 2007; 16(Suppl 1):S173–S175. PMID: 18063361.

3. Liu ST, Wu CT, Yeh CC, Ho ST, Wong CS, Jao SW, et al. Premedication with dextromethorphan provides posthemorrhoidectomy pain relief. Dis Colon Rectum. 2000; 43:507–510. PMID: 10789747.

4. Watt-Watson J, Chung F, Chan VW, McGillion M. Pain management following discharge after ambulatory same-day surgery. J Nurs Manag. 2004; 12:153–161. PMID: 15089952.

5. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. Anesth Analg. 2000; 90:1402–1405. PMID: 10825328.

6. Singelyn FJ, Aye F, Gouverneur JM. Continuous popliteal sciatic nerve block: an original technique to provide postoperative analgesia after foot surgery. Anesth Analg. 1997; 84:383–386. PMID: 9024034.

7. Kilbride M, Morse M, Senagore A. Transdermal fentanyl improves management of postoperative hemorrhoidectomy pain. Dis Colon Rectum. 1994; 37:1070–1072. PMID: 7956571.

8. Chester JF, Stanford BJ, Gazet JC. Analgesic benefit of locally injected bupivacaine after hemorrhoidectomy. Dis Colon Rectum. 1990; 33:487–489. PMID: 2351001.

9. Brunicardi FC, Brandt ML, Andersen DK, Billiar TR, Dunn DL, Hunter JG, et al. Schwartz's principles of surgery. 2010. 9th ed. New York: McGraw-Hill;p. 342–358.

10. Lally KP, Cox CS Jr, Andrassy RJ. Townsend CM, Beauchamp RD, Evers ME, Mattox KL, editors. History of appendicitis. Sabistone textbook of surgery: the biological basis of modern surgical practice. 2001. 16th ed. Philadelphia: Saunders;p. 919.

11. Imbelloni LE, Vieira EM, Gouveia MA, Netinho JG, Spirandelli LD, Cordeiro JA. Pudendal block with bupivacaine for postoperative pain relief. Dis Colon Rectum. 2007; 50:1656–1661. PMID: 17701375.

12. Naja Z, Ziade MF, Lönnqvist PA. Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain. Can J Anaesth. 2005; 52:62–68. PMID: 15625258.

13. Naja Z, El-Rajab M, Al-Tannir M, Ziade F, Zbibo R, Oweidat M, et al. Nerve stimulator guided pudendal nerve block versus general anesthesia for hemorrhoidectomy. Can J Anaesth. 2006; 53:579–585. PMID: 16738292.

14. Crile GW. Phylogenetic association in relation to certain medical problems. Boston Med Surg J. 1910; 163:893–904.

15. Kehlet H. The modifying effect of anesthetic technique on the metabolic and endocrine responses to anesthesia and surgery. Acta Anaesthesiol Belg. 1988; 39:143–146. PMID: 3057785.

16. Rodrigues MR, Paes FC, Duarte LT, Nunes LG, Costa VV, Saraiva RA. Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block. Rev Bras Anestesiol. 2009; 59:684–693. PMID: 20011858.