Abstract / Summary
Abstract Purpose To compare a modified multimodal local infiltration cocktail with liposomal bupivacaine (LB) for pain control and recovery after mixed hemorrhoid surgery. Methods 360 patients were assigned 1:1 to perianal infiltration with LB or a modified cocktail containing ropivacaine, dexamethasone, magnesium sulfate, and sodium bicarbonate. The primary outcome was the dynamic numeric rating scale (NRS) trajectory from 6 h to postoperative day 7. Secondary outcomes included analgesic use, recovery, and adverse events; hospital costs were explored separately. Results Dynamic NRS trajectories differed between groups (group-by-time interaction, P < 0.001). Adjusted scores were lower with the modified cocktail at 6 and 12 h (mean differences,−0.86 and−0.61; both P < 0.001), with no statistically significant differences thereafter. The modified cocktail also reduced first-defecation pain, the proportion requiring rescue analgesia within 24 h (38.3% vs 48.9%), and 24-h opioid consumption; it was also associated with earlier ambulation. No statistically significant differences were detected in resting pain, gastrointestinal recovery, QoR−15, length of stay, wound healing, defecation function, or 72-h opioid consumption. An exploratory analysis showed lower hospital costs, and no serious adverse events occurred. Conclusion Compared with LB, the modified cocktail modestly reduced early movement- and defecation-related pain and reduced rescue analgesic use and opioid consumption within 24 h; it was also associated with earlier ambulation. No statistically significant differences were detected in later pain or most other short-term outcomes. Further multicenter evaluation is warranted. Trial registration: Chinese Clinical Trial Registry, ChiCTR2600116630; registered 13 January 2026.