The use of topical anaesthetic in the banding of internal haemorrhoids: a feasibility study for a randomised control trial

INTRODUCTION

Rubber band ligation (RBL) is a procedure commonly performed in colorectal clinics for internal haemorrhoids. Overall, 90% of patients experience pain following RBL. We aimed to complete a feasibility randomised control trial assessing the role of topical anaesthetic before RBL of internal haemorrhoids.

METHODS

We performed a prospective, single-centre, single blinded, randomised (1:1) control feasibility trial. Patients presenting with symptomatic haemorrhoids suitable for banding were randomised to undergo the procedure with local anaesthetic or without (control). Pain scores and vasovagal symptoms were assessed at 0 minutes, 30 minutes, 4 hours and 72 hours after the procedure. Primary outcome measures were recruitment rate, participant retention rate and patient and surgeon acceptability. Secondary outcome measures were pain scores up to 72 hours, vasovagal episodes, new use of analgesia and adverse outcomes.

RESULTS

In total, 35 patients (18 topical anaesthetic, group A; 17 no anaesthetic gel, group B) were recruited. Mean recruitment rate was 11.7 participants per month. Thirty-three (94%) participants remained in the study until completion, with two patients lost to telephone follow-up. The treatment was acceptable for 35 (97%) eligible patients. One patient declined enrolment. The treatment was acceptable to all surgeons (100%). There was a significant difference in median pain scores of -2 (95% CI -4.0 to -1.0, p=0.0006) at the 30-minute time point only. There was no significant difference in vasovagal symptoms (p=0.10) or new analgesia use (p=0.85).

CONCLUSION

We have shown that a phase III clinical trial is feasible for assessing the role of topical anaesthetic before RBL of internal haemorrhoids. We have demonstrated excellent patient recruitment and retention as well as patient and surgeon acceptability.

73 The Use of Topical Anaesthetic in The Banding of Internal Haemorrhoids: A Feasibility Study for A Randomized Control Trial

Aim

Rubber band ligation (RBL) is a procedure commonly performed in colorectal clinics for internal haemorrhoids. 90% of patients experience pain following RBL. We aimed to complete a feasibility randomized control trial assessing the role of topical anaesthetic before RBL of internal haemorrhoids.

Method

We performed a prospective, single-centre, single blinded, randomized(1:1) controlled feasibility trial. Patients presenting with symptomatic haemorrhoids suitable for banding were randomized to undergo the procedure with local anaesthetic or without(control). Pain scores and vasovagal symptoms were assessed at 0 minutes, 30minutes, 4 hours, and 72 hours after the procedure. Primary outcome measures were recruitment rate, participant retention rate, patient and surgeon acceptability. Secondary outcome measures were pain scores up to 72 hours, vasovagal episodes, new use of analgesia, and adverse outcomes.

Results

35 patients (18 topical anaesthetic, group A; 17 no anaesthetic gel, group B) were recruited. Mean recruitment rate was 11.7 participants per month. 33(94%) participants remained in the study until completion, with 2 patients lost to telephone follow-up. The treatment was acceptable for 35(97%) eligible patients. 1 patient declined enrolment. The treatment was acceptable to all surgeons (100%). There was a significant difference in median pain scores of -2(95% CI -4.0 to -1.0, p = 0.0006) at the 30-minute time point only. There was no significant difference in vasovagal symptoms(p = 0.10) or new analgesia use(p = 0.85).

Conclusions

In conclusion, we have shown that a phase III clinical trial is feasible. We have demonstrated excellent patient recruitment and retention as well as patient and surgeon acceptability.

852 Complete Mesocolic Excision (CME) Versus Conventional Surgery for Colon Cancer: A Systematic Review and Metaanalysis

Introduction

Complete mesocolic excision (CME) lacks consistent data to advocate operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta-analyses, analysing peri-operative, pathological, and oncological outcomes.

Method

A systematic literature review was registered with PROSPERO and carried out using PRISMA guidelines. Outcomes reviewed included lymph node yield, R0, disease free and overall survival at five years.

Results

3039 citations were identified; 148 studies underwent full-text reviews and 34 matched our inclusion criteria. There were no significant differences between the CME and non-CME group in overall complications (13.8% vs.13.8%) or anastomotic leak (1.3% vs. 1.7%). Nodal yield was higher in the CME group, 18.7 compared to 13.6 in the non-CME group. The rate of R0 resection was 96.8% in CME compared to 95.5%. Overall survival at five years was higher in the CME group 77.8% compared to 69.7% in non-CME group.

Conclusions

CME for colon cancer was associated with no significant differences in morbidity and mortality, better lymph node yield and R0 resection compared to the non-CME group. Our meta-analysis further supported this demonstrating an improved overall and disease-free survival at five years in the CME group compared to the non-CME group.

Stability of neurological soft signs in chronically hospitalized schizophrenic patients

Neurological soft signs (NSS) have been shown to be more prevalent in chronically ill and in acute or never-mediated patients with schizophrenia. If neurological soft signs are trait-like, then NSS scores should be relatively stable over time and should not be related to changes in patients' psychopathology or medication. Chronically hospitalized patients with schizophrenia were rated two or more times over a 5-year period with standard NSS and psychopathology scales. Total NSS scores were highly correlated over time, and changes in NSS scores at two time points were not significantly related to changes in psychopathology scores. Total NSS scores did not change significantly in a subsample rated when they were first treated with a traditional neuroleptic and later with an atypical neuroleptic. The findings suggest total NSS scores may have some characteristics of a trait-like feature in chronically hospitalized patients with schizophrenia.