Caudal clonidine added to local anaesthetics for post-operative analgesia after anal surgery in adults - abstract

Duration of postopertive analgesia with caudal local anesthetics is increased by the addition of clonidine in children. To assess its efficacy in adults, we undertook a prospective, randomized, double-blind study in adults undergoing elective haemorrhoidectomy. Fifty-eight patients were randomly allocated to one of two groups. Caudal anaesthesia was performed with 0.5 percent isobarbic bupivacaine 35 mg (7 ml) in 2 percent lidocaine 140 mg (7 ml) and epinephrine 1/200000. Clonidine 75 mg was added in Group C, and saline (1ml) in group S. Duration of analgesia, defined as the time from the caudal injection to the first request for supplemental analgesics, was recorded as well as the time for the first micturition, haemodynamic changes and sedation. No differences were found between groups for demographic data, sedation and the time to first micturition. The mean (ñSEM) duration of analgesia was longer in group C(729 ñ 120 min) than in group S (276 ñ 131 min) (p=0.01). Hypotension and sedation was not marked in our study. Bradycardia was more frequent in the clonidine group but had no haemodynamic repercussions. We conclude that the duration of postoperative analgesia with caudal local anaesthetics was significantly increased by the addition of 75 mg of clonidine without major side effects. (AU)

Band ligation versus haemorrhoidectomy for piles - abstract

A prospective policy to treat 100 patients with haemorrhoids by rubber band ligation (RBL) was undertaken, and compared to 100 patients who previously had Milligan-Morgan haemorrhoidectomy (MMH). Of the 100 cases who presented for RBL, only 9 required MMH. None of the patients who had RBL lost time from work of required hospitalization, compared to the MMH group, 21 days and 1.3 days, respectively. No patient in the RBL group required anaesthesia or operating theatre time. None of the RBL group required narcotic analgesics but 17 used non-narcotics for one day. Patients who had MMH averaged 3.6 doses of narcotics, and used non-narcotic for an average of 16 days. Stool softners were used by all patients in the MMH group and by only 8 in the RBL group. In view of these considerable benefits, RBL should be adopted as the treatment of choice for haemorrhoids in the West Indies(AU)

Immediate operation for prolapsed thrombosed haemorrhoids

Results of operations for prolapsed thrombosed haemorrhoids are compared with the results of routine haemorrhoidectomy. The long tradition that this operation is dangerous, does not seem to be supported by this small series of cases(AU)

The treatment of haemorrhoids

The diagnosis, differential diagnosis and grading of Haemorrhoids is outlined. Appropriate lines of treatment of the major types of such lesions are discussed and the rationale of therapy is given. Some of the common complications of haemorrhoids are also presented (AU)