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

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.