대한대장항문학회

Purpose: Hemorrhoidectomy can be associated with severe pain in the immediate po<br>stoperative period. The aim of this study was to evaluate the advantages and fea<br>sibility of hemorrhoidectomy under local anesthesia (pudendal nerve block).<br>Methods: From september 1998 to August 2000 we performed 77 hemorrhoidectomy wit<br>h local anesthesia in our Colorectal unit under the ambulatory surgery regimen.<br>0.5% lidocaine and 0.25% bupivacaine mixed by 1：1 ratio were used for pudendal<br>nerve block and local anesthesia.<br>Results: Using pudendal nerve block, ambulatory hemorrhoidectomy with or without<br>band ligation were done in 77 patients. Male to female ratio was 46：31, mean a<br>ge was 35.2 years. 3 major piles plus 1 minor pile were present in 40 patients (<br>51.9%). We injected mixed lidocaine and bupivacaine solution through external sp<br>hincter and puborectalis muscle. All patients were successfully operated without<br>conversion to general anesthesia or even intravenous anesthetic injection. Post<br>operative pain of them were compared the patients who were operated hemorrhoidec<br>tomy under general (spinal or caudal) anesthesia during the same time. The pain<br>were assessed using verbal rating pain scale at 24 hours, 48 hours and 72 hours<br>(1∼10, where 1 presented no pain and 10 represented the worst pain imaginable)<br>by phone call examination. Mean pain scores for pudendal anesthesia group at 24,<br>48, 72 hours were 5.32, 3.07 and 2.21, respectively, compared with other anesth<br>esia group with 6.47, 4.52 and 3.24. These differences were statistically signif<br>icant (P value＜0.05). Post operative pain was successfully controlled with home<br>care and oral medications.<br>Conclusions: Under local anesthesia with pudendal nerve block, ambulatory hemorr<br>hoidectomy were able to decrease pain and urinary retension in comparison to spi<br>nal or caudal anesthesia group. Ambulatory hemorrhoidectomy is useful, low cost<br>and feasible.<br>