A Randomized, Double-Blind Trial Comparing Pudendal Block Versus Sacral ESP for Ambulatory Hemorrhoidectomy

What this Trial Is About

Researchers are evaluating whether the sacral erector spinae plane (ESP) block provides equal or better pain relief compared to the pudendal nerve block in adults undergoing hemorrhoid surgery. This trial focuses on which block offers more effective pain control and faster recovery after ambulatory hemorrhoidectomy. The study is a randomized, controlled, double-blind trial designed to compare these two pain management techniques. Participants will be randomly assigned to receive either an ultrasound-guided sacral ESP block with ropivacaine and a placebo pudendal nerve block with saline, or a pudendal nerve block with ropivacaine and a placebo sacral ESP block with saline. Both blocks involve a 20 mL injection of either 0.75% ropivacaine or saline. This double-dummy design maintains blinding for patients, anesthesiologists, and outcome assessors. The study includes 64 adult patients undergoing elective hemorrhoidectomy under spinal anesthesia. Throughout the study, participants will be assessed for pain intensity using a 10-point Visual Analog Scale (VAS) at 4, 12, and 24 hours after surgery. Researchers will also monitor time to first rescue analgesia, total opioid use, recovery milestones like mobilization and ability to void, and any block-related or systemic adverse events. The total participation lasts through the immediate postoperative period with assessments continuing up to 24 hours after surgery to evaluate the effectiveness and safety of each block.

PUSHES (Pudendal Block Versus Sacral ESP Hemorrhoidectomy Study)