Effectiveness of Bupivacaine after Rubber Band Ligation of Hemorrhoids for Post Procedure Pain

Qamaruddin Baloch, Usama Iqbal, Farhan Zaheer, Imrana Aziz


Introduction: Pain is the most common complication of rubber band ligation (RBL) of hemorrhoids when
compared to other non-operative techniques to treat hemorrhoids. Local anesthetic injection has been used in
a few studies to reduce pain after RBL but its routine use is still not established. We evaluated the effectiveness
of local injection of bupivacaine after RBL of hemorrhoids to reduce pain after the procedure.
Objective: To compare the mean pain scores by visual analogue scale with and without local injection of
bupivacaine after RBL of 1st and 2nd degree hemorrhoids.
Design: Randomized controlled trial.
Material and Methods: Study was conducted in Surgical unit 1, Civil Hospital, Karachi, for a period of 2
months, from Aug 17, 2016 to Oct 17, 2016. 60 patients having first and second degree hemorrhoids were
included in the study from OPD by non-probability consecutive sampling. They were randomized to either to
receive local injection of bupivacaine or no injection after RBL of hemorrhoids by closed envelop method. Pain
score at 2 hours after the procedure was the main outcome measured.
Results: Our study showed that there was a significant reduction in the pain at 2 hours after RBL of hemorrhoids
with the use of local bupivacaine injection, mean pain scores 3.30 ± 1.055 when compared to 3.93 ± 0.944 in
patients without administration of bupivacaine with p-value = 0.017.
Conclusion: Our study concluded that local bupivacaine injection may be used routinely after RBL of hemorrhoids
to reduce pain after the procedure.


Hemorrhoids, bupivacaine, local anesthetic, rubber band ligation, visual analogue scale.

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