A randomized controlled study on the analgesic effect of perianal local infiltration with liposomal bupivacaine injection in Milligan-Morgan hemorrhoidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIANG Yaxin ¹ , YANG Huiju ¹ , JI Erfeng ¹ , LIU Xiang ¹ , CUI Shichao ¹ , CHEN Kaixuan ² , ZHANG Wei ³ , CAI Yuhui ⁴ ,  LIU Dianwen ¹

1. Department of Proctology, The Third Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450003, P. R. China;
2. Department of Proctology, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou 450003, P. R. China;
3. Department of Proctology, Zhengzhou Hospital for Largeintestinal and Anal Diseases, Zhengzhou 450003, P. R. China;
4. Department of Proctology, Puyang People’s Hospital, Puyang, Henan 457000, P. R. China;

Corresponding author：

LIU Dianwen, Email: liudianwen6207@126.com

Keywords：

mixed hemorrhoid; liposome bupivacaine; local infiltration anesthesia; Milligan-Morgan hemorrhoidectomy; analgesic effect

DOI：

10.7507/1007-9424.202502055

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Objective To explore the analgesic effect of local infiltration anesthesia with liposome bupivacaine (LB) injection after Milligan-Morgan hemorrhoidectomy through a multicenter, double-blind, randomized controlled study. Methods A prospective study was conducted on 240 patients with mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou Hospital for Largeintestinal and Anal Diseases, and Puyang People’s Hospital between December 2023 and June 2024. Patients were randomly divided into an observation group (receiving LB injection) and a control group (receiving methylene blue injection) using a random number table. Postoperative outcomes including anal pain scores, insomnia scores, postoperative wound edema scores, urination, time to first defecation, pain during first defecation, perianal sensory recovery time, hospital stay, need for additional analgesic medication, and postoperative complications were compared between the two groups. Results Among 240 patients, 238 completed the study and were included in the analysis, with 119 patients in the observation group and 119 in the control group. ① There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). ② Postoperative anal pain scores at 6 h, 12 h, 24 h, 48 h, 72 h, and 5 d were lower in the observation group than that in the control group (P<0.05). ③ Postoperative insomnia scores on days 1, 2, 3, and 5 were lower in the observation group compared with the control group (P<0.05). ④ Postoperative edema scores on days 3, 5, and 7 were lower in the observation group than that in the control group (P<0.001). ⑤ The observation group showed superior outcomes compared to the control group in the following parameters: postoperative 24 h urination score [0 vs. 0, Z=–2.528, P=0.011], time to first defecation [2 d vs. 2 d, Z=–2.638, P=0.008], pain score at first defecation [3 vs. 5, Z=–9.846, P<0.001], time to recovery of perianal sensation [2 d vs. 1 d, Z=–4.977, P<0.001], hospital stay [6 d vs. 11 d, Z=–12.170, P<0.001], supplemental analgesic medication need at 7 d postoperation [20.2% (24/119) vs. 80.7% (96/119), χ² = 87.132, P<0.001]. No statistically significant differences were observed between the two groups in the incidence of complications such as: postoperative nausea [6.7% (8/119) vs. 8.4% (10/119), χ² = 0.240, P=0.624], vomiting [5.0% (6/119) vs. 7.6% (9/119), χ² = 0.640, P=0.424], dizziness [1.7% (2/119) vs. 4.2% (5/119), χ²=1.325, P=0.250]. Conclusion Local infiltration anesthesia with LB after Milligan-Morgan hemorrhoidectomy significantly reduces postoperative pain, insomnia, and edema, shortens hospital stays, and accelerates postoperative recovery.

Citation： JIANG Yaxin, YANG Huiju, JI Erfeng, LIU Xiang, CUI Shichao, CHEN Kaixuan, ZHANG Wei, CAI Yuhui, LIU Dianwen. A randomized controlled study on the analgesic effect of perianal local infiltration with liposomal bupivacaine injection in Milligan-Morgan hemorrhoidectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(10): 1296-1303. doi: 10.7507/1007-9424.202502055 Copy

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1. Xu S, Qiu J, Zhang H, et al. Influences of Hiao’s double-C nursing model combined with pain care on postoperative satisfaction with pain control and complications in patients with mixed hemorrhoids. Am J Transl Res, 2021, 13(9): 10676-10684.
2. 汪铁钢, 端传友, 吴国魁, 等. 齿线上方黏膜C形切除吻合术治疗Ⅳ度混合痔的疗效及术后复发情况分析. 中国普外基础与临床杂志, 2024, 31(6): 726-732.
3. 中国中西医结合学会大肠肛门病专业委员会. 中国痔病诊疗指南 (2020). 结直肠肛门外科, 2020, 26(5): 519-533.
4. Cemil A, Ugur K, Salih GM, et al. Comparison of laser hemorrhoidoplasty and Milligan-Morgan hemorrhoidectomy techniques in the treatment of grade 2 and 3 hemorrhoidal disease. Am Surg, 2024, 90(4): 662-671.
5. 汤慧丽, 郑德, 王奕韵, 等. 穴位埋线防治混合痔术后疼痛的临床疗效观察. 上海中医药大学学报, 2022, 36(4): 36-40, 51.
6. 中华医学会麻醉学分会. 成人手术后疼痛处理专家共识. 临床麻醉学杂志, 2017, 33(9): 911-917.
7. 中华医学会胸心血管外科学分会胸腔镜外科学组, 中国医师协会胸外科医师分会微创外科专家委员会. 中国胸外科围手术期疼痛管理专家共识 (2018版). 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.
8. 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南 (2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
9. 全军麻醉与复苏学专业委员会, 中华医学会麻醉学分会, 陆军军医大学第一附属医院, 等. 战创伤疼痛管理专家共识. 麻醉安全与质控, 2020, 4(5): 256-261.
10. 国家卫生健康委员会医管中心加速康复外科专家委员会, 浙江省医师协会临床药师专家委员会, 浙江省药学会医院药学专业委员会. 中国加速康复外科围手术期非甾体抗炎药临床应用专家共识. 中华普通外科杂志, 2019, 34(3): 283-288.
11. Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia, 2020, 75 Suppl 1: e101-e110. doi: 10.1111/anae.14868.
12. Prabhakar A, Ward CT, Watson M, et al. Liposomal bupivacaine and novel local anesthetic formulations. Best Pract Res Clin Anaesthesiol, 2019, 33(4): 425-432.
13. Ilfeld BM, Eisenach JC, Gabriel RA. Clinical effectiveness of liposomal bupivacaine administered by infiltration or peripheral nerve block to treat postoperative pain. Anesthesiology, 2021, 134(2): 283-344.
14. 邓梦秋, 蒋鑫, 袁红斌. 布比卡因脂质体exparel应用研究进展. 海军军医大学学报, 2023, 44(8): 965-970.
15. 陈红风. 中医外科学. 北京: 中国中医药出版社, 2016: 22-23, 27.
16. 用文明, 徐根贤. 手术并发症学. 北京: 中国中医药出版社, 1999: 142.
17. 刘剑, 王春晓, 刘德龙, 等. 基于经络理论研究电刺激腧穴改善肛门病术后疼痛的疗效与机制. 中华中医药学刊, 2025, 43(2): 92-95.
18. 查德华, 张玉玲, 汪伟, 等. 凉血地黄汤加减对混合痔术后创面愈合时间的影响及其机制研究. 安徽中医药大学学报, 2020, 39(4): 17-20.
19. 王霞, 吴洲鹏. 下肢血管疾病患者的围术期疼痛管理进展. 中国普外基础与临床杂志, 2024, 31(4): 508-512.
20. 刘旭升, 刘鉴霄, 彭博, 等. 肠道菌群与术后疼痛的研究进展: 机制与临床应用前景. 中国普外基础与临床杂志, 2024, 31(12): 1534-1539.
21. 彭粤, 邓嘉丽, 邓梦娟, 等. 布比卡因脂质体在胸椎旁神经阻滞乳腺手术后镇痛的临床观察. 麻醉安全与质控, 2025, 7(5): 384-388.
22. 宋晓慧, 肖海洋, 巩发才, 等. 次髎穴埋线治疗对混合痔病人术后疼痛和营养状况的影响. 肠外与肠内营养, 2024, 31(1): 36-39.
23. 陈敏, 戴洪山, 江志伟, 等. 多模式镇痛方案在腹腔镜袖状胃切除术后疼痛管理中的应用. 中国药房, 2024, 35(21): 2658-2662.
24. 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南 (2021) (一). 协和医学杂志, 2021, 12(5): 624-631.
25. 李亮, 唐晓勇, 刘强光, 等. 超声引导下局部浸润麻醉在静脉腔内射频闭合术治疗大隐静脉曲张中的临床应用. 中国普外基础与临床杂志, 2020, 27(4): 423-428.
26. 王鑫智, 张林忠. 手术部位局部浸润麻醉用于术后镇痛的应用进展. 实用药物与临床, 2024, 27(10): 784-789.
27. 韩武臣, 向永国. 阳和汤加减联合依那西普对阳虚寒湿型强直性脊柱炎患者骨密度、骨代谢指标及ESR、CRP水平的影响. 现代中西医结合杂志, 2020, 29(13): 1405-1409.
28. 张建华, 李鹏, 李德, 等. 亚甲蓝混合液应用于肛肠疾病术后的研究进展. 中国医药指南, 2025, 23(1): 61-64.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A randomized controlled study on the analgesic effect of perianal local infiltration with liposomal bupivacaine injection in Milligan-Morgan hemorrhoidectomy

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