Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control

Tazdina Hoque Khan; Minhajul Hasan Chowdhury; Tahira Benzir

doi:doi:10.11648/j.cmr.20261501.11

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Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control

Tazdina Hoque Khan^*, Minhajul Hasan Chowdhury, Tahira Benzir

Published in Clinical Medicine Research (Volume 15, Issue 1)

Received: 19 November 2025 Accepted: 26 January 2026 Published: 11 February 2026

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Abstract

Background: Severe postoperative pain is common after haemorrhoidectomy and can delay recovery and discharge. While spinal anaesthesia provides good intraoperative analgesia, its postoperative effect is short-lived. This study aimed to compare the efficacy of an adjuvant perineal block combined with spinal anaesthesia versus spinal anaesthesia alone for postoperative pain control. Methods: In this randomized, double-blind controlled trial, 68 patients (ASA I–III) scheduled for elective open haemorrhoidectomy were assigned into two groups: Group A (Block Group): spinal anaesthesia with 0.5% hyperbaric bupivacaine followed by posterior perineal block using 20 ml of 0.25% bupivacaine; Group B (Control Group): spinal anaesthesia alone. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 12, 24 and 48 hours. Secondary outcomes included time to first rescue analgesic, total opioid consumption, urinary retention, nausea/vomiting, and patient satisfaction. Results: Patients in Group A had significantly lower mean VAS scores at all postoperative intervals, with the greatest difference at 6 hours (3.1 ± 1.2 vs 5.2 ± 1.4; p < 0.001). The mean time to first analgesic request was prolonged in the Block Group (312 ± 56 min) compared to Control (182 ± 48 min). Total 24-hour opioid requirement was reduced by approximately 40%. Incidence of urinary retention and nausea/vomiting was similar between groups. No local anaesthetic toxicity or block-related complications occurred. Conclusion: Adding a perineal block to spinal anaesthesia significantly enhances postoperative pain control, delays the need for rescue analgesia, and lowers opioid consumption without added risk. This combined approach may be recommended as an effective, safe analgesic technique after haemorrhoidectomy.

Published in	Clinical Medicine Research (Volume 15, Issue 1)
DOI	10.11648/j.cmr.20261501.11
Page(s)	1-5
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Haemorrhoidectomy, Postoperative Pain, Perineal Block

References

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[4]	Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief. Curr Opin Anaesthesiol. 2005; 18(5): 565-569.
[5]	Gupta A. Spinal anesthesia side-effects and management. Indian J Anaesth. 2018; 62(9): 673-679.
[6]	Ng JH et al. Pudendal and perianal blocks in anorectal surgery: a review. Tech Coloproctol. 2014; 18(7): 593-601.
[7]	Shukla A et al. Role of perianal block in postoperative analgesia after hemorrhoidectomy. Indian J Surg. 2014; 76(2): 114-118.
[8]	Ala S et al. Perianal infiltration with local anesthetic reduces postoperative pain after hemorrhoidectomy. Dis Colon Rectum. 2008; 51(2): 231-235.
[9]	Belyamani A et al. Pudendal nerve block combined with spinal anesthesia improves postoperative analgesia. Regional Anesthesia & Pain Medicine. 2016; 41(3): 400-406.
[10]	EisharkawyH, Pino C. Regional anesthesia in colorectal surgery: current perspectives. Local RegAnesth. 2020; 13: 11-22.
[11]	Khan ZH, Aghamohammadi D, Mirakhorli M, Heshmatipour M, Ramezani H. The effect of pudendal nerve block on post-hemorrhoidectomy pain: a double-blind randomized controlled trial. Colorectal Dis. 2023; 15(2): 203-7.
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APA Style

Khan, T. H., Chowdhury, M. H., Benzir, T. (2026). Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control. Clinical Medicine Research, 15(1), 1-5. https://doi.org/10.11648/j.cmr.20261501.11

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ACS Style

Khan, T. H.; Chowdhury, M. H.; Benzir, T. Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control. Clin. Med. Res. 2026, 15(1), 1-5. doi: 10.11648/j.cmr.20261501.11

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AMA Style

Khan TH, Chowdhury MH, Benzir T. Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control. Clin Med Res. 2026;15(1):1-5. doi: 10.11648/j.cmr.20261501.11

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@article{10.11648/j.cmr.20261501.11,
  author = {Tazdina Hoque Khan and Minhajul Hasan Chowdhury and Tahira Benzir},
  title = {Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control},
  journal = {Clinical Medicine Research},
  volume = {15},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.cmr.20261501.11},
  url = {https://doi.org/10.11648/j.cmr.20261501.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20261501.11},
  abstract = {Background: Severe postoperative pain is common after haemorrhoidectomy and can delay recovery and discharge. While spinal anaesthesia provides good intraoperative analgesia, its postoperative effect is short-lived. This study aimed to compare the efficacy of an adjuvant perineal block combined with spinal anaesthesia versus spinal anaesthesia alone for postoperative pain control. Methods: In this randomized, double-blind controlled trial, 68 patients (ASA I–III) scheduled for elective open haemorrhoidectomy were assigned into two groups: Group A (Block Group): spinal anaesthesia with 0.5% hyperbaric bupivacaine followed by posterior perineal block using 20 ml of 0.25% bupivacaine; Group B (Control Group): spinal anaesthesia alone. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 12, 24 and 48 hours. Secondary outcomes included time to first rescue analgesic, total opioid consumption, urinary retention, nausea/vomiting, and patient satisfaction. Results: Patients in Group A had significantly lower mean VAS scores at all postoperative intervals, with the greatest difference at 6 hours (3.1 ± 1.2 vs 5.2 ± 1.4; p  Conclusion: Adding a perineal block to spinal anaesthesia significantly enhances postoperative pain control, delays the need for rescue analgesia, and lowers opioid consumption without added risk. This combined approach may be recommended as an effective, safe analgesic technique after haemorrhoidectomy.},
 year = {2026}
}

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TY  - JOUR
T1  - Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control
AU  - Tazdina Hoque Khan
AU  - Minhajul Hasan Chowdhury
AU  - Tahira Benzir
Y1  - 2026/02/11
PY  - 2026
N1  - https://doi.org/10.11648/j.cmr.20261501.11
DO  - 10.11648/j.cmr.20261501.11
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 1
EP  - 5
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20261501.11
AB  - Background: Severe postoperative pain is common after haemorrhoidectomy and can delay recovery and discharge. While spinal anaesthesia provides good intraoperative analgesia, its postoperative effect is short-lived. This study aimed to compare the efficacy of an adjuvant perineal block combined with spinal anaesthesia versus spinal anaesthesia alone for postoperative pain control. Methods: In this randomized, double-blind controlled trial, 68 patients (ASA I–III) scheduled for elective open haemorrhoidectomy were assigned into two groups: Group A (Block Group): spinal anaesthesia with 0.5% hyperbaric bupivacaine followed by posterior perineal block using 20 ml of 0.25% bupivacaine; Group B (Control Group): spinal anaesthesia alone. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 12, 24 and 48 hours. Secondary outcomes included time to first rescue analgesic, total opioid consumption, urinary retention, nausea/vomiting, and patient satisfaction. Results: Patients in Group A had significantly lower mean VAS scores at all postoperative intervals, with the greatest difference at 6 hours (3.1 ± 1.2 vs 5.2 ± 1.4; p  Conclusion: Adding a perineal block to spinal anaesthesia significantly enhances postoperative pain control, delays the need for rescue analgesia, and lowers opioid consumption without added risk. This combined approach may be recommended as an effective, safe analgesic technique after haemorrhoidectomy.
VL  - 15
IS  - 1
ER  -

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Author Information

Tazdina Hoque Khan

Department of Surgery, Chittagong Medical College Hospital, Chattagram, Bangladesh

Contact Email
Minhajul Hasan Chowdhury

Department of Vascular Surgery, Chittagong Medical College Hospital, Chattagram, Bangladesh
Tahira Benzir

Department of Surgery, Chittagong Medical College Hospital, Chattagram, Bangladesh

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APA Style

Khan, T. H., Chowdhury, M. H., Benzir, T. (2026). Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control. Clinical Medicine Research, 15(1), 1-5. https://doi.org/10.11648/j.cmr.20261501.11

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ACS Style

Khan, T. H.; Chowdhury, M. H.; Benzir, T. Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control. Clin. Med. Res. 2026, 15(1), 1-5. doi: 10.11648/j.cmr.20261501.11

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AMA Style

Khan TH, Chowdhury MH, Benzir T. Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control. Clin Med Res. 2026;15(1):1-5. doi: 10.11648/j.cmr.20261501.11

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@article{10.11648/j.cmr.20261501.11,
  author = {Tazdina Hoque Khan and Minhajul Hasan Chowdhury and Tahira Benzir},
  title = {Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control},
  journal = {Clinical Medicine Research},
  volume = {15},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.cmr.20261501.11},
  url = {https://doi.org/10.11648/j.cmr.20261501.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20261501.11},
  abstract = {Background: Severe postoperative pain is common after haemorrhoidectomy and can delay recovery and discharge. While spinal anaesthesia provides good intraoperative analgesia, its postoperative effect is short-lived. This study aimed to compare the efficacy of an adjuvant perineal block combined with spinal anaesthesia versus spinal anaesthesia alone for postoperative pain control. Methods: In this randomized, double-blind controlled trial, 68 patients (ASA I–III) scheduled for elective open haemorrhoidectomy were assigned into two groups: Group A (Block Group): spinal anaesthesia with 0.5% hyperbaric bupivacaine followed by posterior perineal block using 20 ml of 0.25% bupivacaine; Group B (Control Group): spinal anaesthesia alone. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 12, 24 and 48 hours. Secondary outcomes included time to first rescue analgesic, total opioid consumption, urinary retention, nausea/vomiting, and patient satisfaction. Results: Patients in Group A had significantly lower mean VAS scores at all postoperative intervals, with the greatest difference at 6 hours (3.1 ± 1.2 vs 5.2 ± 1.4; p  Conclusion: Adding a perineal block to spinal anaesthesia significantly enhances postoperative pain control, delays the need for rescue analgesia, and lowers opioid consumption without added risk. This combined approach may be recommended as an effective, safe analgesic technique after haemorrhoidectomy.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - Comparative Study Between Adjuvant Perineal Block and Spinal Anaesthesia Alone for Post-haemorrhoidectomy Pain Control
AU  - Tazdina Hoque Khan
AU  - Minhajul Hasan Chowdhury
AU  - Tahira Benzir
Y1  - 2026/02/11
PY  - 2026
N1  - https://doi.org/10.11648/j.cmr.20261501.11
DO  - 10.11648/j.cmr.20261501.11
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 1
EP  - 5
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20261501.11
AB  - Background: Severe postoperative pain is common after haemorrhoidectomy and can delay recovery and discharge. While spinal anaesthesia provides good intraoperative analgesia, its postoperative effect is short-lived. This study aimed to compare the efficacy of an adjuvant perineal block combined with spinal anaesthesia versus spinal anaesthesia alone for postoperative pain control. Methods: In this randomized, double-blind controlled trial, 68 patients (ASA I–III) scheduled for elective open haemorrhoidectomy were assigned into two groups: Group A (Block Group): spinal anaesthesia with 0.5% hyperbaric bupivacaine followed by posterior perineal block using 20 ml of 0.25% bupivacaine; Group B (Control Group): spinal anaesthesia alone. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 12, 24 and 48 hours. Secondary outcomes included time to first rescue analgesic, total opioid consumption, urinary retention, nausea/vomiting, and patient satisfaction. Results: Patients in Group A had significantly lower mean VAS scores at all postoperative intervals, with the greatest difference at 6 hours (3.1 ± 1.2 vs 5.2 ± 1.4; p  Conclusion: Adding a perineal block to spinal anaesthesia significantly enhances postoperative pain control, delays the need for rescue analgesia, and lowers opioid consumption without added risk. This combined approach may be recommended as an effective, safe analgesic technique after haemorrhoidectomy.
VL  - 15
IS  - 1
ER  -

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