Comparison Of Open Hemorrhoidectomy Under Local Anesthesia Versus Saddle Block: A Cost-Effectiveness And Clinical Outcomes Analysis

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 the financial burden on healthcare systems.