The use of local anaesthesia in haemorrhoidal banding: a randomized controlled trial H. C. K. Kwok*, S. E. Noblett*, N. E. A. Murray†, A. E. H. Merrie*, J. L. Hayes* and I. P. Bissett† *Department of Surgery, Auckland City Hospital, Auckland, New Zealand and †University of Auckland, Auckland, New Zealand Received 24 April 2012; accepted 24 September 2012; Accepted Article online 16 January 2013 Abstract Aim Rubber band ligation is a common office procedure for the treatment of symptomatic haemorrhoids. It can be associated with pain and vasovagal symptoms. The effect of local anaesthetic use during banding was studied. Method A single-blinded randomized controlled trial was carried out in the colorectal outpatient clinic. Patients presenting with symptomatic haemorrhoids suitable for banding were prospectively recruited and randomized to undergo the procedure with local anaes- thetic or without (control). Submucosal bupivacaine was injected immediately after banding just proximal to the site. Vasovagal symptoms were assessed at the time of banding and pain scores (visual analogue scale) were recorded at the conclusion of the procedure, after 15 min, and on leaving the clinic. Results Seventy-two patients (40 local anaesthetic injec- tion, group 1; 32 no injection, group 2) were recruited. The mean ages were 50 and 54 years respectively, the median duration of symptoms was 12 months in each group and the median number of haemorrhoids banded was three in each group. The mean pain score on leav- ing the clinic was 2.6 (95% CI 2.1, 3.1) in group 1 and 4.1 (95% CI 3.3, 5.0) (P = 0.04) in group 2. There were no complications related to local anaesthetic use. No significant difference in vasovagal symptoms was found (P = 0.832). Conclusion Local anaesthetic injection at the time of banding is simple and safe. It may reduce patient dis- comfort following banding of haemorrhoids. Keywords Haemorrhoids, local anaesthetic, banding, analgesia, randomized controlled trial What is new in this paper? Submucous injection of local anaesthetic after banding of haemorrhoids reduces discomfort compared with no local anaesthetic. Introduction Rubber band ligation is a simple and effective treatment for symptomatic haemorrhoids. Pain after banding is common and reduces patient acceptance and satisfaction of this treatment. It has been reported that up to 90% of patients experience some degree of pain following haem- orrhoidal banding and 40% develop vasovagal symptoms [1]. Local anaesthetic injection has been proposed to reduce pain associated with banding [2], although two randomized controlled trials have shown conflicting results [3,4]. These discrepancies may reflect differences in technique; specifically we postulated that local anaes- thetic injection deep to the banded tissue (Fig. 1) would be more effective than injection into the devitalized banded tissue. The purpose of this randomized con- trolled study was to assess the efficacy of local anaesthet- ics in reducing post-banding pain using this technique. Method All patients presenting to the colorectal outpatient clinic with symptomatic haemorrhoids suitable for banding were considered for inclusion. Patients were excluded if they did not speak sufficient English or if there were confounding factors such as a pre-existing anorectal Correspondence to: Ian Bissett, Department of Surgery, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand. E-mail: i.bissett@auckland.ac.nz Randomized controlled trial (registered with the Australian New Zealand Clinical Trials Registry #ACTRN12610001000099). Classifications: 10.2, haemorrhoids; 100.11, pain management. Abstract presented at the Royal Australasian College of Surgeons Annual Scientific Congress in Adelaide, Australia, 2–6 May 2011. ª 2013 The Authors Colorectal Disease ª 2013 The Association of Coloproctology of Great Britain and Ireland. 15, 487–491 487 Original article doi:10.1111/codi.12088