Sirikurnpiboon Siripong, Siripattanakul Anusorn
J Med Assoc Thai. 2017 Feb;100 Suppl 1:S33-9.
Hemorrhoidectomy is a common procedure in clinical practice. Most operations are performed on an inpatient basis using general or regional anesthesia, and the use of local anesthesia is still limited due to concerns about postoperative care.
To compare perioperative results including pain, urinary retention, bleeding and other complications after hemorrhoidectomy performed using local anesthesia (LA) on an out-patient basis with those achieved after spinal anesthesia (SA) on in-patient cases.
This was a retrospective study of closed hemorrhoidectomy of grade 3 hemorrhoids performed under local and spinal anesthesia between March 2011 and March 2014 in the Department of Surgery, Rajavithi Hospital, Bangkok.
A total of 91 patients with third-degree internal hemorrhoids were recruited. The subjects were divided into two groups with 50 patients in the LA group and 41 in the SA one. Early complications were similar in the two groups: patients in the LA group had more postoperative pain with visual analog (VAS) scores at 6 hours postoperatively of 8.8±1.26 compared with 5.3±1.09 (p<0.001) in the SA group, but at 24 hours postoperatively the LA patients had less pain with mean VAS scores of 6.5±1.25 compared with 7.29±1.15 (p = 0.002) in the SA group.
Hemorrhoidectomy under local anesthesia, with proper counseling and consent, is safe and feasible for use on an outpatient basis.
痔切除术是临床实践中的常见手术。大多数手术在住院患者中进行，采用全身麻醉或区域麻醉，由于对术后护理的担忧，局部麻醉的使用仍然有限。
比较门诊局部麻醉（LA）下痔切除术后与住院脊髓麻醉（SA）下痔切除术后的围手术期结果，包括疼痛、尿潴留、出血和其他并发症。
这是一项对2011年3月至2014年3月在曼谷拉贾维蒂医院外科进行的3级痔闭合性痔切除术的回顾性研究，手术在局部麻醉和脊髓麻醉下进行。
共招募了91例三度内痔患者。受试者分为两组，LA组50例，SA组41例。两组的早期并发症相似：LA组患者术后疼痛更明显，术后6小时视觉模拟评分（VAS）为8.8±1.26，而SA组为5.3±1.09（p<0.001），但术后24小时LA组患者疼痛较轻，平均VAS评分为6.5±1.25，而SA组为7.29±1.15（p = 0.002）。
在适当的咨询和同意下，局部麻醉下的痔切除术在门诊使用是安全可行的。
