What type of anesthesia is required for a rubber band ligation (RBL) procedure for hemorrhoids?

From the Guidelines

No anesthesia is required for a banding procedure for hemorrhoids, as the procedure is typically performed above the dentate line where there are fewer pain receptors. The procedure involves placing rubber bands around the base of internal hemorrhoids, which are located in an area with minimal sensory nerve endings 1. Patients may feel a sensation of pressure or mild discomfort rather than sharp pain. In some cases where patients are particularly anxious or sensitive, a topical anesthetic such as lidocaine gel or cream may be applied to reduce discomfort.

Key Points to Consider

• The American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids states that rubber band ligation can be performed in the office setting without anesthesia 1.
• The procedure is most commonly used for first-, second-, or third-degree hemorrhoids, and up to 3 hemorrhoids can be banded in a single session 1.
• The most common complication of rubber band ligation is pain, which is reported in 5%–60% of treated patients, but this pain is usually minor and can be managed with sitz baths and over-the-counter analgesics 1.
• Proper technique and placement of the band are essential to avoid significant pain, which can occur if the banding is placed below the dentate line 1.

Additional Considerations

• Some authorities recommend rubber band ligation for fourth-degree hemorrhoids after operative reduction of the incarcerated prolapse 1.
• The success rates of rubber band ligation vary depending on the degree of hemorrhoids treated, length of follow-up, and criteria for success, with reported success rates ranging from 69% to 89% 1.
• The recurrence rate may be as high as 68% at 4 or 5 years of follow-up, but symptoms usually respond to repeat ligation, and only 10% of such patients require excisional hemorrhoidectomy 1.

From the Research

Anesthesia for Hemorrhoid Banding Procedure

• The type of anesthesia needed for a banding procedure for hemorrhoids is typically local anesthesia, as it has been shown to reduce patient discomfort following the procedure 2.
• A study published in 2013 found that the use of local anesthesia, specifically submucosal bupivacaine, during banding reduced pain scores in patients compared to those who did not receive local anesthesia 2.
• Another study from 2007 reported that rubber band ligation (RBL) performed in outpatients for symptomatic hemorrhoids using the O'Regan Disposable Bander device was associated with a good response and low complication rate, but did not specifically mention the use of anesthesia 3.
• A review of hemorrhoid diagnosis and treatment options published in 2018 noted that office-based treatment of grades I to III internal hemorrhoids with rubber band ligation is a preferred next step after initial medical management, but did not discuss anesthesia in detail 4.

Key Findings

• Local anesthesia, such as submucosal bupivacaine, can reduce pain and discomfort during and after the banding procedure 2.
• The use of local anesthesia is simple and safe, with no significant complications reported in one study 2.
• Rubber band ligation is a safe and effective treatment option for symptomatic hemorrhoids, with a low complication rate 3.