COMPARISON OF OPEN HEMORRHOIDECTOMY UNDER LOCAL ANESTHESIA VERSUS SADDLE BLOCK: A COST-EFFECTIVENESS AND CLINICAL OUTCOMES ANALYSIS

Abstract

Mohammed Fouad Azhari*, Ahmed Khalid Bawazer, Hesham Emad Abdelmaqsoud, Abdullah waheeb shafey, Abdullah Ali Mohammed Albariqi, Jaber Mohammed Jaber Albariqi, Yaser Mohammed alnouri, Ali Saeed Alqahtani, Muaid Ali Batayib, Nuwayyir bint Suwailem bin Salim Al-Nusairi Al- Sh and Adnan Mohammed Ali Alsaleem

Background: Haemorrhoids are a common anorectal disorder requiring surgical intervention in severe cases. Open haemorrhoidectomy (OH) is a widely performed procedure, with anaesthesia choice significantly impacting patient outcomes and healthcare costs. While saddle block (SB) anaesthesia is frequently used, local anaesthesia (LA) has been proposed as a cost-effective and efficient alternative, especially in resource-limited settings.

Methods: A double-blind, randomized controlled trial (RCT) was conducted to compare the clinical and economic outcomes of OH performed under LA versus SB. A total of 80 patients with 3rd or 4th-degree haemorrhoids were randomly assigned into two groups (40 per group). The study evaluated operative time, hospital stay duration, and cost-effectiveness using a bottom-up cost analysis approach. Data were analyzed using IBM SPSS Statistics, with statistical significance set at p<0.05.

Results: The mean operating time was significantly shorter in the LA group compared to the SB group (p<0.001). Patients receiving LA also had reduced hospital stays (p<0.001). The total cost per patient was lower in the LA group compared to SB (p=0.04). While patients under LA reported slightly higher post-operative pain in the first few hours, there was no significant difference in overall complications between the groups.

Conclusion: Local anaesthesia for open haemorrhoidectomy is a cost-effective alternative to saddle block, resulting in shorter hospital stays, reduced surgical costs, and comparable clinical outcomes. Implementing LA as a first-line anaesthetic technique in resource-limited settings could enhance surgical efficiency and reduce