48 - Preissitzung
Felix Largiadèr Preissitzung
16. Mai 2019, 10:15 - 11:45, Bellavista 3+4, 6. OG
Double blind randomized placebo-controlled trial of perianal block for postoperative analgesia in proctology
N. Rotigliano, I. Füglistaler, M. O. Guenin, D. Freiermuth, G. B. Dursunoglu, M. von Flüe, D. C. Steinemann, Presenter: N. Rotigliano (Basel)
Safety and short-term efficacy of perianal block as sole anesthesia in proctologic interventions have been demonstrated before. However, in Switzerland, perianal block is more frequently used as an adjunct to general or regional anesthesia for postoperative pain control. This study aims to evaluate the influence of adjunct perianal block for prolonged pain control after proctologic surgery.
138 patients undergoing surgery for hemorrhoids, anal fistula or anal fissures were randomized in two equal groups. The intervention group received 40 milliliters of 0.5% ropivacaine solution injected in each perianal quadrant. The control group received perianal injection of 40 milliliters of 0.9% NaCl solution. Patients, surgeons and assessors were blinded for the group allocation. Pain was assessed using a numeric rating scale (NRS; 0=no pain, 10= strongest pain) at 1, 2, 3, 12, and 24 hours after surgery. The need for opiates was monitored in the first 24 hours and calculated in intravenous morphine equivalents. Primary outcome was pain 24 hours after surgery.
Patients were allocated to perianal ropivacaine or placebo as an adjunct to general (n=41 and 43) or spinal anesthesia (28 and 26; p=0.86) between february and december 2018. Within the groups surgery for hemorrhoids (42 and 40), fistulas (22 and 24), and fissures (5 each) were equally distributed (p=0.93). Mean NRS was lower in patients that received perianal block with ropivacaine (1.2±0.2) compared to placebo (1.8±0.3; p=0.042) 24 hours after surgery. Lower NRS were also found 1 hour (1.1±0.2 and 2.0±0.3; p=0.01), 2 hours (0.8±0.2 and 1.3±0.2; p=0.03), 3 hours (0.8±0.18 and 1.3±0.2; p=0.04), and 12 hours (0.9±0.2 and 1.6±0.2; p=0.01) after surgery in the intervention group compared to placebo. The need for opiates was reduced in the ropivacaine (3.1±0.6 mg) versus the placebo group (5.0±0.7mg, p=0.04).
Perianal block as an adjunct to general or spinal anesthesia in proctology reduces postoperative pain and analgesia requirements even beyond the duration of action of ropivacaine. Considering the ongoing trend towards ambulatory surgery perianal block may gain even more attraction.