Liposomal Bupivacaine vs Ropivacaine for Post-hemorrhoidectomy Analgesia

Milligan‐Morgan open hemorrhoidectomy is associated with substantial postoperative paindue to rich somatic innervation of the perianal region, wound exposure, anal sphincterspasm, and stimulation during defecation. Optimizing postoperative analgesia is criticalfor enhanced recovery. Local wound infiltration with ropivacaine is commonly used butprovides limited duration of analgesia. Liposomal bupivacaine, formulated with amultivesicular liposomal delivery system, enables sustained release of bupivacaine at theinjection site and may prolong local analgesia. However, high‐quality comparativeevidence between liposomal bupivacaine and ropivacaine for wound infiltration after openhemorrhoidectomy remains limited.This single‐center, prospective, randomized, double‐blind controlled trial enrolledpatients aged 18‐60 years with grade III‐IV internal hemorrhoids or mixed hemorrhoidsscheduled for elective Milligan‐Morgan open hemorrhoidectomy at Tongliao People'sHospital between November 2025 and May 2026. Patients were randomized 1:1 to receiveperianal wound infiltration with either 266 mg of liposomal bupivacaine or 200 mg ofropivacaine hydrochloride, both diluted to 30 mL with normal saline and divided into six5‐mL aliquots infiltrated at six predefined perianal clock‐face positions. All patientsreceived spinal anesthesia with 15 mg of 0.5% hyperbaric bupivacaine. Rescue analgesiawith oral diclofenac sodium 50 mg was provided when VAS pain score was ≥4.The primary outcome is resting VAS pain score at 24 hours postoperatively. Secondaryoutcomes include resting and movement‐evoked VAS pain scores at 4, 6, 12, 24, and 48hours, cumulative diclofenac sodium consumption during postoperative days 1‐3, QoR‐40total scores on postoperative days 1‐3, and adverse events (nausea and vomiting, rash,lower‐extremity numbness or weakness, local anesthetic systemic toxicity, perianalhematoma, surgical‐site infection) within 72 hours.