Local injection of bupivacaine after rubber band ligation of hemorrhoids

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Abstract
PURPOSE: The aim of this study was to determine if local injection of bupivacaine after hemorrhoidal banding causes a decrease in pain and in the incidence of associated symptoms. METHODS: After hemorrhoidal banding, patients were randomly assigned to receive a local injection of bupivacaine with 1:200,000 epinephrine, an injection of normal saline, or no injection, just superior to each band. Pain was graded by the patient and by the study nurse within 30 minutes, and any associated symptoms were recorded. At intervals 6, 24, and 48 hours postbanding, the patient recorded pain, limitation of activities, and analgesic requirements. Associated symptoms while at home were recorded. RESULTS: Of 115 patients studied, 42 received bupivacaine injection, 42 received normal saline injection, and 31 received no injection. In patients receiving bupivacaine compared with no injection, within 30 minutes postbanding there was a significant reduction in pain graded by the patient (P=0.000002) and by the nurse (P=0.000005) and a significant reduction in incidence of nausea (P=0.01) and shaking (P=0.008). However, in the bupivacaine group compared with the other two groups, at the intervals of 6, 24, and 48 hours postbanding there was no sustained reduction in the severity of pain and no reduction in analgesic requirements or limitation of normal activities. In the week after banding, there was no difference between groups in symptoms of nausea, shaking, lightheadedness, urinary retention, or bleeding. CONCLUSIONS: Bupivacaine injection may be useful for reducing pain and associated symptoms long enough to tolerate a trip home from the outpatient department but does not show a sustained effect.