Proactive local anesthesia with ropivacaine in the prevention of pain after hemorrhoidectomy

Abstract

Introduction. Assessment of proactive local anesthesia’s influence on how early postoperative period after hemorrhoidectomy undergoes. Materials and methods. The object of the study were 50 patients operated on for chronic combined hemorrhoids (stage 3). In the period from November 2018 to June 2019, they all had open hemorrhoidectomy made according to the standard method. All operations were performed under spinal anesthesia. Patients were divided into the main group (n = 26), operated on under proactive local anesthesia (PLA) with 0,75% ropivacaine solution and a comparison group (n = 24) that had not had PLA. The introduction was carried out immediately before hemorrhoidectomy after the spinal block was performed at 5 points. Pain was assessed with the help of questionnaires based on a visual analogue scale (VAS), 2, 4, 8, 24, 48 hours after surgery. Results. The level of postoperative pain in the main group was lower than in the comparison group (p <0.05) and did not exceed 1,78 points by VAS. In the comparison group, the level of postoperative pain after 8 and 24 hours on average exceeded 5 points by VAS. Patients of the main group did not need postoperative anesthesia in 68,5% (n = 17) cases, while in the comparison group 57% patients (n = 17), needed from 3 to 5 injections of NSAID to provide adequate pain relief. Conclusion. The use of a 0,75% ropivacaine solution for PLA reduces pain after hemorrhoidectomy, which does not lead to the need for additional analgesia in the early postoperative period and improves the patient’s quality of life.