Comparison of the analgesic effect of different local anesthetics via four-point perianal infiltration combined with PCIA after mixed hemorrhoid surgery

ZOU Run-lin; ZHOU Jian-ling; ZENG Yan-ru

doi:10.13820/j.cnki.gdyx.20252185

Abstract：Objective To evaluate the analgesic effect of four-point local infiltration with different local anes-thetics combined with patient-controlled intravenous analgesia(PCIA)after mixed hemorrhoid surgery.Methods A to-tal of 80 patients undergoing L4-5 spinal anesthesia for mixed hemorrhoid surgery were randomly assigned into two groups.The study group(B,n=40)received four-point perianal infiltration of liposomal bupivacaine 266 mg(20 mL)at 3,6,9,and 12 o'clock positions,while the control group(C,n=40)received 0.375％bupivacaine 20 mL in the same man-ner.Both groups received sufentanil 1 μg/mL via PCIA,with intravenous flurbiprofen axetil 50 mg for rescue analgesia.Outcomes included PC A pump first press time,total presses within 72 h,sufentanil consumption,flurbiprofen use,VAS pain scores at 8-72 h,and adverse events(dizziness,nausea,vomiting,drowsiness,respiratory depression).Results VAS scores at 0-12 h were similar between groups.At 24 h,48 h,72 h,the B group showed significantly lower VAS scores,longer first PCA press time,fewer total PC A presses,and lower sufentanil consumption than the C group(P＜0.01).Flurbiprofen rescue doses and incidence of nausea,vomiting,and dizziness were lower in B group(P＜0.01).No respiratory depression or significant drowsiness occurred.Hospital stay was shorter in B group[(5.4±2.3)d]com-pared with C group[(7.3±2.9)d,P＜0.01].One-month follow-up showed no difference in Wexner anal function scores(P＞0.05).Conclusion Four-point perianal infiltration with liposomal bupivacaine provides effective postoper-ative analgesia for mixed hemorrhoid surgery,reduces PCIA opioid consumption,shortens hospital stay,and has minimal adverse effects,making it a favorable clinical option.