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Posterior Perineal Block with Ropivacaine 0.75% for Pain Control During and After Hemorrhoidectomy
  1. Georges Brunat, M.D.,
  2. Yvan Pouzeratte, M.D.,
  3. Claude Mann, M.D., Ph.D.,
  4. Jean-Michel Didelot, M.D.,
  5. Jean-Claude Rochon, M.D. and
  6. Jean-Jacques Eledjam, M.D.
  1. From the Departments of Anesthesiology B (G.B., Y.P., C.M., J-J.E) and Enterology (J-M.D., J-C.R.), University of Montpellier, Montpellier, France.
  1. Reprint requests: Jean-Jacques Eledjam, M.D., Professor and Head, Department of Anesthesiology, DAR B, Ho???pital Saint Eloi, University of Montpellier, 34295 Montpellier cedex 5, France. E-mail: jj-eledjam{at}


Background and Objectives As perioperative pain management is a difficult challenge during hemorrhoidectomy, we tested the hypothesis that posterior perineal block (PPB) with local anesthetics alone is able to provide adequate pain control during and after surgery.

Methods In a prospective, blinded, randomized study, we studied analgesic conditions and side effects of PPB in American Society of Anesthesiologists (ASA) I-II patients undergoing hemorrhoidectomy. Patients received general anesthesia (GA) either with PPB (0.75% ropivacaine, 40 mL (PPB group) or without PPB (control group). All patients received intravenous morphine patient-controlled analgesia (PCA) for postoperative pain control (morphine, 1.5 mg-boluses, 8-minute lockout interval). Intra- and postoperative opioids consumption was recorded, and pain assessments were performed at 1, 2, 4, 8, 12, and 24 hours using a visual analog scale (VAS).

Results VAS scores were significantly lower during the first 8 postoperative hours in the PPB group as compared with the control group (P < .001). The PPB group required significantly less opioids during anesthesia (P < .001) and during the first postoperative day (P < .001) as compared with the control group. Time to first defecation and duration of hospitalization were identical in both groups.

Conclusions The present study shows that PPB with 40 mL 0.75% ropivacaine (300 mg) was a simple, effective, and safe method to provide better postoperative analgesia than PCA alone following surgical hemorrhoidectomy. In addition, PPB was shown to significantly reduce opioid consumption intraoperatively and during the first postoperative day.

  • Hemorrhoidectomy
  • Postoperative care
  • Postoperative pain management
  • Posterior perineal block
  • Ropivacaine

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  • Presented in part at the 8th Annual Congress of the European Society of Anaesthesiologists, Vienna, Austria, 1999, and at the 42nd Annual Meeting of Société Franc,aise d’Anesthe???sie et de Reéanimation, Paris, France, April 1-4, 2000.