A Randomized Controlled trial on the usefulness of Intra-sphincteric bupivacaine-Lignocaine Injection in the treatment of Painful Anal Fissure

To evaluate the usefulness of a long-lasting local anesthetic injection into the anal sphincter in the treatment of painful anal fissure-in-ano.

A prospective randomized controlled study, in a Medical College teaching hospital Surgical out-patient department, to compare relief of pain and reduction in need for rescue operation between conventional conservative treatment and an added single intervention, namely intra-sphincteric injection of long-lasting local anesthetic, both groups being offered the rescue at the end of the trial.

240 adult patients complaining of painful anal fissure were enrolled in the study. After recording baseline data in a predesigned proforma, the controls were given conventional treatment consisting of stool softeners and topical lignocaine jelly while the Intervention group was treated identically except that, in addition, they were given an injection of bupivacaine-lignocaine into their anal sphincter muscle. All participants were evaluated one month after initiation of treatment for relief of pain and for their perceived need of surgical intervention.

Of the 240 volunteers enrolled in the study, 110 of the Control group and 108 of the Intervention group were available for follow-up after one month. 70 (64.8%) of the Intervention group claimed full relief of pain, and 66 (61.1%) of them did not need rescue surgery, as compared to 53 (48.2%) and 55 (50%) of the Controls.

Intra-sphincteric injection of the long-lasting local anesthetic solution as described, significantly improves the cure-rate of painful anal fissures and significantly reduces the need for operative intervention.