University of Iowa Hospitals and Clinics Iowa City, IA
Elizabeth Brindise, DO, MPH1, Shana Kothari, MD2, Charles Berkelhammer, MD2; 1University of Iowa Hospitals and Clinics, Iowa City, IA; 2University of Illinois at Chicago, Advocate Christ Medical Center, Oak Lawn, IL
Introduction: Endoscopic band ligation is effective for the treatment of bleeding internal hemorrhoids. Our group has previously shown that 30% percent of patients undergoing endoscopic band ligation of hemorrhoids complain of moderate to severe rectal pain (Berkelhammer et al, Gastrointestinal Endoscopy 2002, 55:532-537). Post-procedural rectal pain is currently managed with oral or intravenous analgesics. We aim to assess the utility of a lidocaine enema in reducing post-procedural pain after endoscopic band ligation of internal hemorrhoids. Methods: 75 patients undergoing endoscopic band ligation of bleeding internal hemorrhoids were recruited for this single-blinded study. Patients were randomly assigned to the lidocaine enema group or placebo group. Patients underwent band ligation of internal hemorrhoids, such that between 2 – 5 bands were placed above the dentate line. The treatment group received 15 ml of lidocaine gel as an enema immediately upon completion of the procedure. The placebo group did not receive any enema. Both groups were prescribed oral pain medication upon discharge to use on an as needed basis. Pain was assessed using a numeric pain scale (0-10) at 1 hour, 24 hours and 48 hours after the procedure. Narcotic requirement post-procedure was documented. Results: Seventy-two patients were evaluated in the per protocol analysis (37 in the lidocaine group and 35 in the placebo group). There was no significant difference in age (mean age 51.8 vs 49.9, p=0.604) and gender (male 70.3% vs 60%, p=0.459). An average of 4 bands (range 2-5) were placed in both groups. Lidocaine enema use was associated with a decreased post procedural rectal pain score at 1 hour (4.0 vs 5.5, p=0.01). No significant difference in pain score was observed at 24 or 48 hours. There was a trend towards lower pain scores at 24 and 48 hours (3.3 vs 4.9, p=0.054 and 1.6 vs 2.5, p=0.2 respectively), but this did not reach statistical significance. Additionally, procedural lidocaine enema use lead to a decrease in use of post procedural opioids (24.1% vs 60.9%, p=0.01). Lidocaine enema was well-tolerated, and no adverse events were reported. Discussion: Lidocaine enema after band-ligation of internal hemorrhoids is safe and reduces postprocedural pain and narcotic requirements.
(Clinical Trial: NCT03797703)
Disclosures: Elizabeth Brindise indicated no relevant financial relationships. Shana Kothari indicated no relevant financial relationships. Charles Berkelhammer indicated no relevant financial relationships.