Prospective Comparative Analysis of the Incidence of Vasovagal reaction and the effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A randomized controlled trial.

Journal: 2020/March - Annals of Coloproctology

ISSN: 2287-9714

PUBMED: 32178498

DOI: 10.3393/ac.2020.02.12

Abstract:

To evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of a lidocaine injection to prevent its occurrence.Patients (n=117) diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to the submucosal injection used on the rectum into: lidocaine (n=53, lidocaine injected just before full closure of the stapler) and control groups (n=58). Outcomes compared included baseline patient characteristics (ASA class, body mass index, diabetes mellitus, hypertension, previous VVR history), vital signs during the operation, the incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, nausea/vomiting), and postoperative complications (pain, bleeding, urinary retention). Statistical analysis of patient data was performed using the paired t-test and the chi-square test.Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and the incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs 25.9%, p=0.017; 0% vs 8.6%, p=0.035, respectively). However, there were no significant between-group differences in the incidence of nausea and diaphoresis (0% vs 3.4%, p=0.172) and syncope (1.9% vs 3.4%, p=0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs 58.6%, p=0.072) and these patients used analgesics less frequently than those in the control group (28.3% vs 36.2%, p=0.374).Patients who received a submucosal lidocaine injection prior to SH experienced lesser lower abdominal pain and dizziness, than those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

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