• 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;
LIU Dianwen, Email: liudianwen6207@126.com
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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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