Pudendal nerve block versus local anesthesia for harmonic scalpel hemorrhoidectomy: a prospective randomized study

This prospective randomized trial was used to compare two different local anesthetic techniques, local perianal anesthesia and pudendal nerve block, used for harmonic scalpel hemorrhoidectomy (HSH).

A total of 120 patients with grade III or IV hemorrhoids were randomly chosen to perform HSH (60 patients under local anesthesia—Group A and 60 patients under pudendal nerve block—Group B).

Additional perioperative analgesia during the procedure was needed in 37 patients of group A and 18 patients of group B (P < 0.001). A total of 27 patients from group A and 8 patients from group B (P < 0.001) required additional postoperative analgesia apart from the standard administered analgesics. A statistical significant difference in favor of the second group (B)—(P < 0.003) was found regarding the discharge point from the hospital when the number of patients that were able to be discharged from the hospital on the day of the operation and the first postoperative day was the comparison parameter. Group B (P < 0.001) was superior to local group regarding VAS pain score at discharge for the patient group that were discharge on the day of surgery (5.1 vs. 2.2).

These data suggest that HSH performed under pudendal nerve block is a safe and efficient technique.