Background and Goal of Study: Haemorrhoidectomy as ambulatory procedure is becoming more common. Pain after haemorrhoidectomy is very intense and causes delayed discharge and unplanned admission into hospital.Patients receiving a nerve stimulator guided pudendal block (NSGPB) for haemorrhoidectomy could experience an effective and prolonged postoperative analgesia. A prospective study was conducted to investigate the pain relief provided by NSGPB.
Materials and Methods: This is a prospective observational study with 124 consecutive patients undergoing ambulatory haemorrhoidectomy. All cases underwent spinal anaesthesia with lidocaine 2% for the surgical procedure.
Immediately following surgery a bilateral NSGPB with 0.25% L-Bupivacaine (10 ml on each side) was performed.
Each patient was given a logbook and analgesics to take-home. They were asked to self-recorded pain scores according to numerical rating scale (NRS) in recovery, discharge, 12 and 24 hours after surgery.
Pain scores, postoperative complications, re-admissions into hospital and patient's satisfaction were reviewed.
Results and Discussion: Successful pudendal nerve stimulation was achieved in all patients. Early control of postoperative pain was excellent and no one needed opioids. The NRS (mean + confidence interval 95%) pain scores were: 0.65 (0.40-0.90) in recovery, 1.39 (1.14-1.64) at discharge, 3.29 (2.83-3.76) at 12 hours and 2.46 (2.12-2.82) at 24 hours.
Ambulatory surgery was performed in 122 patients (98.38%) and 2 cases (1.62%) became in-patients.
There were no re-admissions into hospital after discharge; no patient went to accident and emergency; nor had complications related to the NSGPB. Patient's satisfaction (percentage, confidence interval 95%) was rated as excellent in 21% (14-29), good in 79% (72 - 86) and none rated regular or bad.
Conclusion(s): In our study NSGPB provided excellent, simple, safe and well accepted analgesia up to 24 hours after haemorrhoidectomy in ambulatory surgery.