Specialists and patients who have undergone anal surgery know that pain after anal surgery is the biggest trouble of this kind of surgery. Many people suffering from anal diseases hear that this kind of surgery is very painful and dare not go to the hospital for surgery, and live with the hidden problems of anal diseases for many years, which is very troublesome. In fact, in the pharmaceutical industry, the problem of pain relief after surgery for anal diseases has been under study, and there are many methods of postoperative pain relief, such as, the method of intra-vertebral tube pre-positioned catheter drug pump, the method of surgical local injection of long-acting anesthetics, the method of injection of methylene chloride, the method of oral or injectable addictive analgesics (pethidine, etorphine, etc.), etc., all of which have certain postoperative pain relief effects. But these are not the most ideal solutions. Pain in the anal part of the wound is with its complex and special physiological function. The local nerve endings in the anus are very rich, and the nerves below the dentate line are innervated by the body, and the sensation is extremely sensitive, especially to pain. When the anal lesion is traumatically operated or stimulated during the treatment, the release of pain-causing substances such as prostaglandins, histamine, 5-tryptamine and bradykinin stimulates the anal dilator muscle, causing it to contract and spasm continuously, resulting in pain. Especially for anal surgery, most of them adopt open surgery, and the postoperative sphincter and wrinkle skin muscles are easy to move or spasm, and pain or even severe pain can easily occur after surgery for defecation and other reasons, which brings greater pain to patients. In addition, patients are fearful, overly nervous, allergic to pain, and feel severe pain when touched lightly. Therefore, post-operative anal pain is caused by both its physiological and mental factors. According to the pain principle, both doctors and patients have put forward the special requirements of pain-free anal surgery and also long-time analgesia after surgery. With the progress of research on pain mechanism and neurophysiology, in recent years, according to the principle of neuroplasticity, we have made some researches on painless techniques of anal surgery by referring to the literature of some scholars and combining with our clinical experience, such as over-the-top analgesia, balanced analgesia, long-acting analgesia, self-control analgesia and comprehensive analgesia, etc., which have been applied to clinical practice and achieved good results. I. Painless techniques for anal surgery 1. meaning and preparation of anesthesia 1. 1 Specialized characteristics of anesthesia for anal surgery Surgery of the lower part of the anorectal canal is generally the scope of outpatient surgery. It requires anesthesia by the anorectal surgeon himself and independent operation. How to improve the quality of anesthesia and ensure the best effect of safety and effectiveness is one of the basic skills of anorectal surgeons. There are many people suffering from anorectal diseases, including the elderly, young children, pregnant women, young adults and other groups at different levels, so an anorectal surgeon requires multidisciplinary knowledge and the ability to handle patients from different disciplines. Different anesthesia methods are selected according to different patients, types of diseases and physical conditions. 1. 2 Ideal anesthetic effect Painless. Under anesthesia, the patient is made to complete the surgery in a painless state. But anesthesia is not limited to painlessness, but also requires sedation. Emotional relaxation, doctor-patient cooperation, avoiding patient fear and anxiety. Relaxation. Relaxation of the muscles without tension. Amnesia. No malignant stimulation to anesthesia and surgery. Lower stress response. Stable physiological internal environment. 1.3 Basic conditions for selecting and performing anesthesia Understanding of the individual meaning of anesthesia; comprehensive knowledge of anesthetics and resuscitation drugs; necessary resuscitation and monitoring equipment; ability to handle emergencies; signing of informed consent. 1.4 Preparation before anesthesia Perfect preoperative preparation is the basis for successful anesthesia surgery. In order to prevent anesthesia accidents and ensure anesthesia effect, a comprehensive medical history should be taken before anesthesia, a comprehensive physical examination should be conducted, and the evaluation of psychological and mental status, cardiopulmonary function, etc. should be carried out. Preparation: blood and urine routine, blood clotting, prothrombin, platelet and other tests. Selection of anesthetic drugs and allergy testing. Necessary preoperative medications. For example; sedative-hypnotics, narcotic analgesics, anticholinergics, antihistamines, H2-blockers – meclizine. Antacids, cardiovascular drugs, such as: nitroglycerin. 2, narcotic analgesics and over-the-top analgesia The concept of over-the-top analgesia; that is, pre-emptive pain control or pre-emptive analgesia. It is a treatment method to prevent central sensitization to form an injurious effect. 2,1 Analgesic drugs are applied before surgery in an attempt to enhance postoperative analgesia and prevent central sensitization. The effect of analgesic drugs is composed of both attenuating the perception of pain and altering the response to pain. While relieving the painful sensation, the unpleasant emotions accompanying the pain can also be reduced, making the pain easily tolerated. Pre-operative oral narcotic analgesics such as morphine, codeine, aminophene, sulforaphane, fentanyl, or non-steroidal analgesics can be used. or non-steroidal analgesics such as diclofenac sodium. To prevent the occurrence of postoperative pain by over-advancing pre-emptive pain control. 2. 2 Clinical application of auricular acupressure for the prevention of postoperative pain. Ear acupuncture point “sympathetic Shenmen brain heart lung rectum lower part of the large intestine” surface paste Wang Bu Liuxing granules to stimulate the acupuncture points of the auricle to prevent postoperative pain a method of pain. The ear is the place where all the veins of Qi and blood converge, and is closely related to the meridians and organs. The theory of biological holography proves that any individual part contains the information of the whole. It is a microcosm of the overall structural and functional information. 2.3 Research on the analgesic effect of the combination of acupuncture and medicine. The use of traditional Chinese medicine transdermal umbilical fusion slow release technology, play the advantages of Chinese medicine dialectic and acupuncture follow the meridian to take the advantages of Rongchang anal tai has a better analgesic effect. 3.Commonly used local anesthetics and dosage The commonly used anesthetics are divided into two categories, lipids: procaine, chloroprocaine, and dicaine. Amides: lidocaine, bupivacaine. According to the anesthesia time is divided into; short-acting: procaine maintenance time 1 – 2 hours, the amount of a time should not exceed 1G. lidocaine is medium-acting, when 2-3 hours each time the dosage does not exceed 0.5G. bupivacaine local anesthetic effect is 4 times that of lidocaine, maintenance of anesthesia time of about 5 – 7 hours, less accumulation in the body, is a relatively safe long-acting local anesthetics. 4.Anesthesia methods commonly used in anal surgery There are local infiltration anesthesia, surface anesthesia, epidural block anesthesia, lumbar anesthesia, sacral anesthesia, ketamine basic anesthesia, isoproterenol intravenous anesthesia, I first choose sacral anesthesia, followed by local anesthesia. 5.Sacral canal anesthesia Sacral canal block anesthesia is a method of injecting anesthetic drugs into the sacral epidural through the sacral fissure, which is a simple single epidural anesthesia. It is located at the lumbar acupuncture point of the Directing Vessel, so some scholars call it “lumbar acupuncture point” anesthesia. Sacral canal anesthesia differs from lumbar acupoint anesthesia in that the sacral canal anesthesia involves a large amount of medication with an oblique entry and flat penetration. Lumbar acupoint anesthesia is simple, safe, and effective in relaxation. 5.1 Historical review: Cathleen first introduced the method of stabbing into the dural cavity from the caudal side in 1901, which has a history of one hundred years. In the 1940s, it was used for painless delivery. Later, it was gradually used for surgical anesthesia. 1978 International Lumbar Symposium concluded that intra-dural and epidural steroid drug injection was the most effective method for the treatment of patients with low back pain. The irreplaceable role of hormone in sacral injection was established. In China, relevant studies and explorations on the anatomy and clinical application of the sacral canal have been conducted since the 1980s. It is considered that sacral canal anesthesia and injection therapy is a safe, rapid and effective method. 5.2 Its characteristics are: clear selection point, simple and easy operation, good relaxation effect, less safety complications, wide application range, besides anal and anal canal surgery, it can also be used for perineal surgery, such as syringomyelia, circumcision, bartholin gland fistula and other general urogynecological surgery. Since the success rate and adverse reactions of sacral anesthesia are directly related to the anatomical factors of the sacrum and sacral canal and the technique of *operation. Therefore, it is necessary to improve the *operative skills and avoid the anatomical unfavorable factors, which can improve the quality of anesthesia, guarantee the anesthetic effect and avoid the occurrence of anesthetic complications. 5.3 Characteristics of sacral anatomy and needle insertion There are two defects behind the sacrum, called lumbosacral space and sacrococcygeal space. Sacral canal block can be entered from these respectively. The lumbosacral space is 3-4 cm high and 2 cm wide in the midriff, generally in a v-shape. The sacrococcygeal space (also called sacral fissure, sacral fissure sulcus, sacral canal fissure) is mostly in the shape of inverted v-shaped triangle. 5,3,1 Body surface markings in relation to puncture; there are small protrusions on each side of the lower part, called sacral angle. The mid-sacral crest terminal bulge, sacral fissure and sacral angle are the main signs of the puncture point of sacral canal anesthesia. 5,3,2 Morphology and variation The morphology and variation of sacral fissure are large, with a width of 4MM —-16MM and a height of 3MM — 20MM. It has been reported that the morphology of sacral fissure is mostly inverted triangular (23%), rectangular (19.4%), square (11.3%), and also horseshoe shaped (20%) and irregular (15%). There are variants such as no sacral angle, no sacral fissure, asymmetrical sacral angle, and sacralization of the coccyx. All these variants can cause obstruction in sacral anesthesia. There are also some obese patients who do not feel any markers at all. Absent or inconspicuous sacral horn inevitably causes difficulties in localizing the sacral horn by touch or from the tip of the coccyx upwards. Variations such as narrow sacral fissure or skewed direction are another reason for puncture failure. Therefore, many doctors and even anesthesia expert Xie Rong also think that the success rate of puncture in this area is low, about 75%, which has weakened its use value to a certain extent. 5. 3. 3 Sacral canal content in relation to puncture The sacral canal is the epidural cavity, the lower end of the dural sac is flat the lower edge of the second sacral vertebra, and the average distance from the stop of the dural sac to the sacral fissure is 4. 7 CM. it is the lowest end of the epidural, so it is the safest. However, there are a few termination variants, which may be anterior that is the dural sac. The distance from the lower end of the sacral horn to the lower end of the dural sac; male; 5. 7CM to 7. 5CM, female; 4. 5 – 6. 4CM This can be used as a reference value for penetration depth. Clinically it should not exceed 3CM, the capsule is in the sacral canal close to the posterior wall and far from the anterior wall, the anterior part is covered with intravertebral venous vascular network with rich anastomosis, the vessels are fixed and inactive, the posterior part is sparser. Therefore, the anterior part of the puncture needle is submerged and prone to bleeding. The sacral nerve roots are located on both sides of the epidural cavity of the sacral canal and are surrounded by fibrous sheaths and fat. The 1st, 2nd and 3rd sacral nerve roots are thicker. The rectum is innervated by sympathetic and parasympathetic nerves, and the anus and anal canal are mainly innervated by the pubic and anal nerves. 5,3,4 Positioning method I have applied sacral anesthesia since the early 1970s, and have accumulated a lot of clinical information and experience, and the success rate of puncture is above 98%. The selection of points is to experience carefully, feel the heart by hand and pay attention to summarize my experience to improve the success rate of puncture. The positioning of the lumbar acupuncture point is the key to the success of anesthesia. A; direct touch method; between the two sacral horns B: indirect touch method, caudal tip method positioning First, feel the tip of the caudal bone with the index finger thumb upwards 4 – 6 CM, press the prominent mark here with the thumb, namely the two sacral horns and the fourth sacral crest, then touch the depression and fissure in its center and make a cross cut, as the puncture point. C: surface localization method; size triangle method An inverted isosceles triangle is formed from the midpoint of the patient’s left and right posterior superior iliac spine line and sacral fissure. The lower vertex is the sacral fissure, i.e. the small triangle. Huang’s generalization is “there is a triangle in the triangle, and the lower part of the triangle is the triangle”. The lower ding angle is the puncture site, and this general summary is quite concise and easy to remember. D: Ding’s vertical line method The midpoint of the line connecting the two posterior superior iliac spines (i.e. the midpoint of sacral 2 spines), and the vertical downward line of 8cm, you can find the depression. E; surface marker method The distance from the midpoint of S2 spine to the midpoint of sacral angle line is 5. 7-7. 5CM, and it can be localized along the positive line from top to bottom. F: 5-bone protrusion localization method Huang adopts 5-bone protrusion localization, and considers that the upper corner of its bony marker triangle is at the terminal expansion of the mid-sacral crest, and the two lower corners of the triangle are the left and right sacral angles, under which there are two caudal angles in a square relationship with the sacral angles. Therefore, during the body surface localization of this triangle and the five bony prominences of the square, no matter how many of them are found, the site of the puncture point can be identified. J;Joint localization method of gluteal end and sacrococcygeal joint It is more successful in obese and localized variant, and it is localized at the depression of about 1-2CM above the gluteal end and sacrococcygeal joint in prone position. 5.5 Puncture technique Take the left lateral recumbent position with both lower limbs flexed, with 5-10ml syringe hand feeling* is more sensitive, and 0.5-1cm vertical needle entry at the selected point is successful. In obese patients with unclear sacral angle markings, the swelling caused by local anesthesia of the skin is dispensed with, and direct puncture is more likely to increase the success rate. The sacral fissure in the triangle is divided into three zones, the upper zone is easy to fail, the middle zone is easy to succeed, and the lower zone is easy to have incomplete anesthesia. If the sacral foramen is long, thin and narrow, the needle tip of the oblique entry method passes through the yellow ligament and the stroke into the sacral canal is longer than the vertical entry, and the feeling of falling through the ligament is obvious. When it is usually not possible to penetrate the sacral canal vertically, it can also be slightly displaced above and below the conventional puncture point, and generally the trial puncture is successful. The signs of the four elements of successful puncture are (1) the feeling of falling. (2) No return of fluid and blood. (3) push the drug without resistance, needle core without compression rebound phenomenon. (4) no swelling of the tissue after drug injection. If the needle is mistakenly pushed into the deep adipose tissue, although the resistance is not great, but the subcutaneous anesthetic accumulation and slight bulge can be seen. After successful puncture with 2% lidocaine 7-8ml rapid injection, after injection and then back to draw no liquid, that is, pull out the needle, ten minutes to achieve the purpose of anesthesia. 5,6 Adverse reflections and treatment Sacral canal anesthesia is a small-scale anesthesia with little systemic effects, and is generally safe, but there are a few cases with toxic symptoms, bleeding, hypotension, and even total spinal anesthesia during anesthesia. A. Bleeding from puncture Bleeding is more common among the adverse reactions, and some people report that 26% of the punctures are successful once and bleeding, but I do not have so many in the clinic, only about 0.6%. It mostly occurs when the feeling of emptying is not obvious and the venous plexus in the sacral canal is damaged by deeper puncture. Especially touching the sacral canal, advancing in the anterior wall, the chance of injury and misfiring into the vessel is higher. For those who have blood in the retraction, immediately withdraw the needle and shift it upward a little, try to penetrate successfully, and inject medicine if there is no blood in the retraction, then give up and use local anesthesia instead. For those who have no blood in the retraction and have symptoms after drug injection, it cannot be denied that negative pressure is generated due to the retraction, which makes the vessel wall block the needle opening and forms a single live flap. Therefore, for those whose puncture is not ideal, we should push and pump, and find blood immediately stop and pull out the needle to reduce the anesthesia caused by the anesthetic entering and seeping into the blood vessels, or symptoms of poisoning. B, accidentally into the subarachnoid space caused by total spinal anesthesia, is a serious complication. The end of the spinal cord is generally flat at the lower edge of the second sacral vertebra, with an abnormal sacral fissure, high fissure position and abnormally low arachnoid end chamber, the higher the chance of puncture into the subarachnoid space. There are reports of death due to total spinal anesthesia caused by sacral anesthesia, and I also successfully resuscitated a patient with total spinal anesthesia caused by sacral anesthesia. The most satisfactory, with the use of small doses of ketamine can prolong the duration of analgesia. Measures to prevent total spinal anesthesia Use the puncture point “rather low than high”. The tip of the tailbone is 5 cm upward, “rather straight than oblique”, “vertical needle”. “It is better to be shallow than deep, and to stop when entering the cavity. It is better to inject “less than more”. Inject 7-8ml of medication is sufficient, and the principle of “pushing while pumping” should be carried out. Closely observe the plane of anesthesia, if the big toe paralysis, restricted movement, suggesting the possibility of total spinal anesthesia, be ready to rescue. C. Lumbar acupoint anesthesia causing specific reaction. It is rare, and the consequences are serious if the treatment is not timely. After drug injection, there is pulse brady BP0/0, coma H, P arrest 6. Analgesic problems of sacral anesthesia for pediatric anal surgery The use of intravenous cannula needle and continuous sacral anesthesia for pediatric anorectal surgery is an ideal choice. The sacral fissure in children is clear and easy to identify, the sacral canal lumen is small, the dura is thin and the nerves are slender, so the sacral canal administration is easily blocked and perfected, which can meet the requirements of painlessness and relaxation. Continuous sacral canal can be repeatedly injected, effectively reducing the risk of local anesthetic poisoning. There are few safety complications, especially for infants and children’s surgery, which is unique. The key to pediatric postoperative analgesia is to find the right dose of drugs, and the analgesic effect is most satisfactory when tramadol 2MG/KG is administered in the sacral canal. The duration of analgesia can be prolonged with a small dose of ketamine. 48H analgesia is not required for 60% of the patients. 7. local anesthesia Local anesthesia has the advantages of simplicity, safety and few complications, but has the shortcomings of poor anal relaxation and pain during injection. Local anesthesia is most commonly used, but it is not the safest anesthesia, and there is a potential risk of poisoning. It is certainly still one of the most important methods in case of failure of sacral anesthesia or when the condition requires it. Although simple and easy to perform, there are problems of technique and experience, and anesthesia skills are important. Local anesthesia in the anorectal department mostly uses the two-point method, four-point method and six-point method of anesthesia. I know that it is more reasonable to use the 3-point method of anesthesia, to enter the needle vertically at 6 points, anesthetize the anal N and anal caudal ligament, retreat to the subcutaneous subtle infiltration to 3 points to 9 points, and then infiltrate from 3 and 9 points area each to 11 points and 1 point area. Rapidly enter the needle to the deep layer and inject while retreating, 2% lidocaine 10ml anesthesia is very effective to achieve a painless state. For small lesions of single thrombosed external hemorrhoids, a small amount of anesthetic can be injected directly into the lesion to achieve the effect of anesthesia painlessly completing the surgery. 8.Ketamine basic anesthesia Its anesthesia state and mode and traditional general anesthesia are very different. It selectively blocks nociceptive impulses to the thalamus and cortical conduction, the site of action in the thalamus, without inhibiting the entire center, excite the limbic lobe of the brain, this dual effect is called “separation of anesthesia”. It can excite the blood vessels, increase the heart rate and BP to 200 MMHG, increase the cerebral blood flow and intracranial pressure, and is suitable for pediatric surgery under 14 years old. Adverse effects; nausea and vomiting, auditory and visual hallucinations, nightmares, and other unpleasant sensations. 9, the application of isoproterenol in anal surgery analgesia isoproterenol because of its rapid onset, short maintenance time, easy to adjust the depth of anesthesia, quick to stop awake, high quality of awakening and is particularly suitable for anal surgery, for patients with acute sensitivity and tension, and patients with perianal abscess, especially with cranial pressure, high intraocular pressure. The use of intravenous anesthesia with isoproterenol is safe and effective, not only to reduce the pain of patients, but also to improve the quality of surgery. Mechanism of action; unclear. Probably a non-specific effect on lipid membranes. It has an effect on central N metabolic channels, decreases cerebral blood flow, cerebral metabolic rate, intracranial pressure and cerebral oxygen consumption, and suppresses electroencephalographic activity. It can cause a decrease in A pressure. Each 200MG/20ML, 500MG/50ML. adverse reactions; painful pain of injection step II. balanced analgesia Also known as combined analgesia, or multi-touch analgesia. In fact, it is a combination of multiple methods to deal with or prevent postoperative pain measures. 1, the standardization of the operation *, 2, the necessary dilation; 3, the severance of the internal sphincter, 4, the unobstructed decompression and drainage 5, the application of local long anesthesia. Through these measures, we can get better treatment effect and painless state, and reduce the occurrence of postoperative complications. The application of long-acting analgesia After surgery, the internal sphincter muscle spasm can occur severe pain, and can cause urination disorders due to pain, so postoperative analgesia is the key to the perioperative period of hemorrhoid fistula, and is also an important issue for the anorectal surgery for many years. In the 1980s, compound menthol (Mendel) was developed for intraoperative anesthesia and postoperative pain relief. Other reports have also reported the use of compound uvain injection, compound Hanfangji injection, Zu Shi Ma, Qiang Xin Ding, Tramadol and Aconite for long-acting pain relief in anal trauma. The mechanism varies, but each has its own advantages and disadvantages. 1, long-acting analgesic drugs 1, 1 methylene chloride long-acting analgesic mechanism has strong neurophilic, 0.2% solution intradermal and subcutaneous injection acts on nerve endings, directly blocking the electrical conduction of nerve fibers, reversibly damaging the medulla of peripheral nerves to produce analgesic effect, and the new medulla is repaired only after about 30 days, so it has a long-acting painless effect. It can last for more than 3-20 days and can prevent postoperative spasmodic pain or urinary retention. However, there is an incubation period of about 4 hours, during which there is an irritating burning pain reaction to local methylene chloride. If combined with the long-acting local anesthetic bupivacaine, the burning pain is avoided. In addition, due to the paralysis of sensory nerves, some patients may have anal overflow and gas overflow, or even the risk of fecal overflow, causing inconvenience to patients. It has been reported that 91.2% of the closed injection rate of this drug at Changqiang acupuncture point is apparent. The principle is that the conduction of the superficial caudal nerve, deep perineal nerve and anal nerve is blocked, which relieves the sphincter spasm and pain caused by surgical stimulation. 1,2 Compound menthol injection is a new type of local analgesic with high efficiency, long-lasting and low toxicity, which not only has good local anesthetic effect, but also can directly achieve the purpose of long-term postoperative pain relief. The pain-relieving effect is maintained for 2-10 days. Local injection has reactive short-term burning pain, and can be injected directly into the sacral canal. 1, 3 The Institute applied Bu Wu combination 6ml local injection, postoperative pain relief up to 3 days or more. Wu Tau liquid is a biological alkaloid proposed by Chuan Wu and Cao Wu, and recent medical scientific research shows that the analgesic site of Wu Tau is in the central N system, mainly in the N structure above the spinal cord, which is a central analgesic and has obvious effect of improving the pain domain, and it is clinically used to treat pain and suffering caused by surgical incision and inflammation with significant efficacy, good pain relief and No toxic reactions. 1,4 Compound Salvia injection 5 – 10ML traumatic injection painless efficiency 92.3%, Salvia has anticoagulation, antithrombotic and calcium antagonistic effect, producing vasodilator effect. Thus, it reduces the aggregation of pain-causing substances. Also in ischemia-reperfusion therapy, Salvia miltiorrhiza counteracts the toxicity of oxygen free radicals and hypercalcemic load, which further reduces pain. The flavonoid compounds in Radix et Rhizoma, not only have strong adrenergic synthase inhibition effect, can inhibit PC coagulation, promote local blood circulation to prevent local aggregation of pain-causing substances, and can improve the pain domain. It has a better clinical analgesic effect. 2.Micro analgesic pump self-control analgesia Some people also use epidural or sacral tube placement after split injection, drip method of drug delivery or use micro analgesic pump, control continuous slow injection, or patient self-control analgesia: analgesics: morphine 5mg (tramadol 100mg), fluparidol 5mg, Bubi 10ml, N.S 100ml/48h analgesic pump self-control analgesia method (PCA). This new analgesic technique is used for postoperative analgesia with good effect, but there are often difficulties in urination, nausea and vomiting from anesthesia non-payment reaction, R inhibition, and the price is high, which is not easy to promote. IV. Comprehensive postoperative analgesia Careful care and correct drug change after anorectal surgery is an important element to ensure smooth healing of wounds, and is also an extremely important link in painless technology. 1.Oral analgesia One of the main reactions to pain within 48 hours after anorectal surgery, the anorectal surgeon should regard the patient’s pain as a “red flag” that draws the doctor’s attention, encourage them to talk if they have pain, promise the patient to stop pain, give analgesics or even central analgesics such as aminogest, morphine, etc. orally as appropriate. The postoperative application of diclofenac anal anal analgesia for preventive analgesia is more effective. 2. Do not fast after surgery, encourage early defecation, and defecate on the second day after surgery. Because the longer the time of stool control, the drier the head of the stool, making the first defecation difficult after surgery, the easier it is to earn to expand the wound causing pain or bleeding; the growth of defecation time, more likely to cause secondary anal edema and pain, increasing pain. After early defecation, cool salt water can be used to wash the sitz bath, which will not increase bleeding, and can reduce pain and complications. 3, change the medicine When the trauma surface should be sprayed with dicaine solution to make the surface anesthetized, then the trauma tunnel should be rinsed and disinfected to eliminate fecal stains and foreign bodies such as ligated threads on the surface. The action should be gentle, disinfection cotton swab or drug application should be thus non-invasive area into, from the trauma face out, so as not to stimulate damage to the trauma surface, causing pain. The thickness of the oil gauze should be appropriate, not too much, should be filled into the traumatic tract, and leave a gap for drainage. 4.Chinese herbal fumigation has a non-negligible role in pain relief and wound healing after anal surgery. It is especially effective for the pain caused by postoperative anal margin swelling. The selection of medicine in the prescription should be based on one’s clinical experience, I mostly use bitter ginseng, cypress, moonstone, Sichuan pepper, white first skin, ice chips, etc., the clinical effect is especially good. It can have the effect of clearing heat, detoxifying, activating blood circulation, resolving blood stasis, reducing swelling and relieving pain. After the sitz bath, you can apply Jiuhua cream, Tai Ning suppository, anal cleansing, or bear bile hemorrhoid cream, moist burn cream. Traumatic helium-neon laser irradiation. Acupuncture, physiotherapy and other measures can also be used to relieve pain and promote wound healing. In conclusion, anal analgesia during and after anal surgery is multi-faceted and multi-disciplinary, and anal surgeons are able to achieve pain-free* work during and after surgery as long as they experience it carefully and pay attention to exploration in their clinical work, so that patients can turn pain into pain during the whole treatment and recovery process.