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Local anaesthetic for pain post rubber band ligation of haemorrhoids: a prospective, single-blinded randomised controlled trial

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Abstract

Background

Rubber band ligation (RBL) is a widely accepted intervention for the treatment of haemorrhoids. However, post procedure pain is a common complaint. The aim of this study was to determine whether the addition of local anaesthetic (LA) to the haemorrhoid pedicle base, post RBL, aids in reducing early post-procedure pain. Additionally, to compare perceived perianal numbness, oral analgesia usage and total consumption, and adverse events.

Methods

This study was a prospective, single-blinded randomised controlled trial. Patients were recruited from colorectal clinics in two Australian hospitals between 2018–2019. Patients randomised to the intervention (LA) group received 2mls bupivacaine 0.5% with adrenaline 1:200,000 to each haemorrhoid base. Patients in the control group were not administered LA. Pain scores were recorded over 48 h using visual analogue scales. Analgesia consumption was documented and other secondary objectives were recorded dichotomously (yes/no).

Results

At 1 h post-procedure, patient reported pain scores were significantly lower in the LA group compared to the control group (p = 0.04). There were no significant differences in pain scores between the groups at 4, 24 or 48 h. Additionally, there were no significant differences between groups with respect to oral analgesia usage, perianal numbness or adverse events.

Conclusions

LA to the haemorrhoid pedicle post RBL may significantly reduce early post procedure pain without any increased risk of adverse effects.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. All data generated or analysed during this study are included in this published article.

References

  1. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR (2018) The American society of colon and rectal surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum 61(3):284–292. https://doi.org/10.1097/dcr.0000000000001030

    Article  PubMed  Google Scholar 

  2. Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL et al (2011) Practice parameters for the management of haemorrhoids (revised 2010). Dis Colon Rectum 54:1059–1064. https://doi.org/10.1097/dcr.0b013e318225513d

    Article  PubMed  Google Scholar 

  3. Technology Committee ASCE, Siddiqui UD, Barth BA, Banerjee S, Bhat YM, Chauhan SS et al (2014) Devices for the endoscopic treatment of haemorrhoids. Gastrointest Endosc 79(1):8–14. https://doi.org/10.1016/j.gie.2013.07.021

    Article  Google Scholar 

  4. Hall JF (2013) Modern management of hemorrhoidal disease. Gastroenterol Clin North Am 42(4):759–772. https://doi.org/10.1016/j.gtc.2013.09.001

    Article  PubMed  Google Scholar 

  5. Iyer VS, Shrier I, Gordon PH (2004) Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal haemorrhoids. Dis Colon Rectum 47(8):1364–1370. https://doi.org/10.1007/s10350-004-0591-2

    Article  CAS  PubMed  Google Scholar 

  6. Law WL, Chu KW (1999) Triple rubber band ligation of hemorrhoids: prospective, randomized trial of use of local anesthetic injection. Dis Colon Rectum 42(3):363–366. https://doi.org/10.1007/bf02236354

    Article  CAS  PubMed  Google Scholar 

  7. Sajid MS, Bhatti MI, Casweel J, Sains P, Baig MK (2015) Local anaesthetic infiltration for the rubber band ligation of early symptomatic haemorrhoids: a systematic review and meta-analysis. Updates Surg 67(1):3–9. https://doi.org/10.1007/s13304-015-0286-3

    Article  CAS  PubMed  Google Scholar 

  8. Hooker GD, Plewes EA, Rajgopal C, Taylor BM (1999) Local injection of bupivacaine after rubber band ligation of hemorrhoids: Prospective, randomized study. Dis Colon Rectum 42(2):174–179. https://doi.org/10.1007/bf02237123

    Article  CAS  PubMed  Google Scholar 

  9. Bleday R, Breen E (2022) UpToDate [Internet]. Home and office treatment of symptomatic haemorrhoids. [Updated 2021 October 05]. Available from: http://www.uptodate.com/contents/home-and-office-treatment-of-syptomatic-hemorrhoids

  10. Khubchandani IT, Paonessa N (2002) Surgical treatment of haemorrhoids, 2nd edn. Springer Science & Business Media, London

    Google Scholar 

  11. Scarpa FJ, Hillis W, Sabetta JR (1988) Pelvic cellulitis: a life-threatening complication of hemorrhoidal banding. Surgery 103(3):383–385

    CAS  PubMed  Google Scholar 

  12. Marshman D, Huber PJ Jr, Timmerman W, Simonton CT, Odom FC, Kaplan ER (1989) Hemorrhoidal ligation. A review of efficacy. Dis Colon Rectum 32(5):369–371. https://doi.org/10.1007/bf02563683

    Article  CAS  PubMed  Google Scholar 

  13. Hardwick RH, Durdey P (1994) Should rubber band ligation of haemorrhoids be performed at the initial outpatient visit? Ann R Coll Surg Engl 76(3):185–187

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Gokalp A, Baskonus I, Maralclan G (2003) A prospective randomised study of local anaesthetic injection after multiple rubber band ligation of haemorrhoids. Chir Ital 55(2):213–217

    PubMed  Google Scholar 

  15. Kwok HC, Noblett SE, Murray NE, Merrie AE, Hayes JL, Bissett IP (2013) The use of local anaesthesia in haemorrhoidal banding: a randomized controlled trial. Colorectal Dis 15(4):487–491. https://doi.org/10.1111/codi.12088

    Article  CAS  PubMed  Google Scholar 

  16. Faculty of pain medicine (2019) Opioid dose equivalence. Australia and New Zealand College of Anaestheists. [Updated 2019 Mar; cited 2022 Jan 1]. Available from https://anzca.edu.au

  17. Sawilowsky SS (2009) New effect size rule of thumb. J Mod Appl Stat Methods 8(2):467–474

    Article  Google Scholar 

  18. Possover M, Forman A (2012) Voiding dysfunction associated with pudendal nerve entrapment. Curr Bladder Dysfunct Rep 7(4):281–285

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

There are no sources of funding to disclose.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Eastern Health, 8 Arnold Street, Box Hill, Victoria, Australia

    C. Steen BSc, MBBS, MSurg, FRACS, Y. M. Cho MBBS, A. Jain MBBS, MSurg, FRACS, V. Balakrishnan MBBS, FRACS, J. Keck MBBS, FRACS, V. An MBBS, FRACS & R. Chandra MBBS, FRACS

  2. University of Edinburgh, Masters of Surgical Sciences, Edinburgh, UK

    C. Steen BSc, MBBS, MSurg, FRACS

  3. Adjunct Research Associate, Monash University, Melbourne, Victoria, Australia

    C. Steen BSc, MBBS, MSurg, FRACS

  4. Swinburne University, VIC, Melbourne, Australia

    M. Scott PhD

  5. Adjunct Senior Lecturer, Monash University, Eastern Clinical School, Box Hill, Victoria, Australia

    V. An MBBS, FRACS & R. Chandra MBBS, FRACS

Authors
  1. C. Steen BSc, MBBS, MSurg, FRACS
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  2. Y. M. Cho MBBS
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  3. M. Scott PhD
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  4. A. Jain MBBS, MSurg, FRACS
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  5. V. Balakrishnan MBBS, FRACS
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  6. J. Keck MBBS, FRACS
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  7. V. An MBBS, FRACS
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  8. R. Chandra MBBS, FRACS
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Contributions

Study concept: CS, VA, RC; study design: CS, YMC, RC; data acquisition: CS, YMC, AJ, VB; statistical analysis: CS, YMC, MS; manuscript preparation: CS, YMC, Monique Scott; manuscript review: all authors contributed to the review of this manuscript.

Corresponding author

Correspondence to C. Steen BSc, MBBS, MSurg, FRACS.

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Steen, C., Cho, Y.M., Scott, M. et al. Local anaesthetic for pain post rubber band ligation of haemorrhoids: a prospective, single-blinded randomised controlled trial. Tech Coloproctol 27, 867–872 (2023). https://doi.org/10.1007/s10151-023-02777-3

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  • DOI: https://doi.org/10.1007/s10151-023-02777-3

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