Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
Colorectal Dis. 2013 Apr;15(4):487-91. doi: 10.1111/codi.12088.
Rubber band ligation is a common office procedure for the treatment of symptomatic haemorrhoids. It can be associated with pain and vasovagal symptoms. The effect of local anaesthetic use during banding was studied.
A single-blinded randomized controlled trial was carried out in the colorectal outpatient clinic. Patients presenting with symptomatic haemorrhoids suitable for banding were prospectively recruited and randomized to undergo the procedure with local anaesthetic or without (control). Submucosal bupivacaine was injected immediately after banding just proximal to the site. Vasovagal symptoms were assessed at the time of banding and pain scores (visual analogue scale) were recorded at the conclusion of the procedure, after 15 min, and on leaving the clinic.
Seventy-two patients (40 local anaesthetic injection, group 1; 32 no injection, group 2) were recruited. The mean ages were 50 and 54 years respectively, the median duration of symptoms was 12 months in each group and the median number of haemorrhoids banded was three in each group. The mean pain score on leaving the clinic was 2.6 (95% CI 2.1, 3.1) in group 1 and 4.1 (95% CI 3.3, 5.0) (P = 0.04) in group 2. There were no complications related to local anaesthetic use. No significant difference in vasovagal symptoms was found (P = 0.832).
Local anaesthetic injection at the time of banding is simple and safe. It may reduce patient discomfort following banding of haemorrhoids.
橡皮圈结扎术是治疗有症状痔的常见门诊手术。它可能会引起疼痛和血管迷走神经症状。本研究旨在探讨结扎过程中使用局麻药的效果。
这是一项在直肠肛门门诊进行的单盲随机对照试验。前瞻性招募有症状的痔患者（适合行结扎术），并随机分为局部麻醉组（在结扎后立即于痔上方黏膜下注射布比卡因）或非麻醉组（对照组）。结扎后即刻、术后 15 分钟和离开诊室时评估血管迷走神经症状，记录疼痛评分（视觉模拟评分法）。
共招募 72 例患者（局部麻醉注射组 40 例，1 组；无注射组 32 例，2 组）。平均年龄分别为 50 岁和 54 岁，症状持续时间中位数均为 12 个月，每组结扎痔的中位数均为 3 个。1 组离开诊室时的平均疼痛评分为 2.6（95%CI：2.1，3.1），2 组为 4.1（95%CI：3.3，5.0）（P=0.04）。局部麻醉使用无相关并发症。两组间血管迷走神经症状无显著差异（P=0.832）。
结扎时注射局麻药操作简单、安全，可能减轻痔结扎术后的不适。
