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Randomized Controlled Trial
. 2017 May-Jun;135(3):247-252.
doi: 10.1590/1516-3180.2017.0001260117. Epub 2017 May 29.

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy

Luis Antônio Borges  1 , Plínio da Cunha Leal  2 , Ed Carlos Rey Moura  3 , Rioko Kimiko Sakata  4
Affiliations
Randomized Controlled Trial

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy

Luis Antônio Borges et al. Sao Paulo Med J. 2017 May-Jun.

Abstract
in English, Portuguese

Background and objectives:: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications.

Design and setting:: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital.

Methods:: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed.

Results:: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention.

Conclusions:: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects.

Registration:: ClinicalTrials.gov NCT02839538.

CONTEXTO E OBJETIVO:: A analgesia pós-operatória e a recuperação precoce são relevantes para a alta hospitalar. O objetivo primário deste estudo foi comparar a eficácia analgésica da infiltração perianal e da anestesia subaracnóidea para hemorroidectomia. O objetivo secundário foi comparar o tempo para alta, efeitos adversos e complicações.

TIPO DE ESTUDO E LOCAL:: Estudo randomizado prospectivo e comparativo, no Hospital Dr. Mário Gatti.

MÉTODOS:: Foram incluídos 40 pacientes com idades 18-60 anos, na categoria 1 ou 2 de status físico da Sociedade Americana de Anestesiologistas. O grupo local (GL) recebeu infiltração local (ropivacaína a 0,75%) sob anestesia geral; o espinal (GS) recebeu bloqueio subaracnóideo (2 ml de bupivacaína a 0,5%). A suplementação analgésica foi com fentanil para GL e lidocaína para GS. Foram avaliados: intensidade da dor no pós-operatório, relaxamento do esfíncter, força dos membros inferiores, tempo de alta, dose de analgésico em uma semana e efeitos adversos.

RESULTADOS:: Onze (52,4%) pacientes em GL necessitaram de complementação, e nenhum em GS. A intensidade da dor foi maior para GL até 120 minutos, sem diferenças em 150 ou 180 minutos. Não houve diferenças na necessidade de paracetamol ou tramadol. O tempo para a primeira complementação analgésica e a alta hospitalar foram maiores para GS. Os efeitos adversos foram náuseas, tonturas e retenção urinária.

CONCLUSÕES:: A intensidade da dor foi maior na GL que na GS nas primeiras 2 horas, porém sem diferenças após 150 e 180 minutos. O tempo para a primeira suplementação foi menor na GL; sem diferenças nas doses de paracetamol e tramadol e efeitos adversos.

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Conflict of interest statement

Conflicts of interest: None

Figures

Figure 1.
Figure 1.. Consort flow diagram.
Table 1.
Table 1.. Sociodemographic and clinical characteristics of participants, according to age, gender, weight, body mass index and ASA physical status
Table 2.
Table 2.. Intensity of pain at each 30 minutes, according to numerical scale (mean ± standard deviation)
Table 3.
Table 3.. Time that elapsed until first postoperative supplementation (after infiltration or spinal block), expressed as mean (minimum-maximum); doses of acetaminophen (mean ± standard deviation, SD); and doses of tramadol (mg) expressed as mean (minimum-maximum)
See this image and copyright information in PMC

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