Many patients resist surgery and always ask me if they can take medication instead, or other treatments. What are people really afraid of? Fear of pain! The imaginary anal surgery is like this: a large incision is made in the anus, and it hurts like a knife when you defecate every day, and beads of sweat fall down. I’ve even had female patients ask me if it hurts more than having a baby! It’s not that scary. With the development of medicine, treatment and examination have become more and more humane, and there are painless colonoscopy, painless gastroscopy, painless abortion, and anal surgery can also be painless. By what means is it possible? Anesthesia. It is the doctor’s responsibility to reduce pain and provide humane treatment. Anesthesia called “propofol” is used for painless abortions, also known as “white milk” because it is a milky white liquid. Propofol is introduced into the body intravenously and can cause a person to fall asleep quickly for about half an hour. There is no discomfort during this procedure. Painless colonoscopy is performed in the same way and takes even less time, more than 20 minutes to complete. The pain of anal surgery, on the other hand, occurs in two parts: first, during the procedure, and second, during the postoperative recovery period. How to avoid pain while ensuring efficacy and allowing patients to enjoy a “humane treatment” is a constant concern. Pain reduction during surgery can be achieved through anesthetics. Initially, local anesthesia was used for anorectal surgery, and many attempts were made to find the most ideal anesthesia. The most used drug was lidocaine, which was safe and fast-acting, but had the disadvantage of being short-lived, lasting only one hour. Later, bupivacaine was used, and the effect lasted longer, three to six hours. The acute onset of pain should be within three hours after surgery, and bupivacaine can help patients reduce pain during this time. A new drug, ropivacaine, has emerged in the last few years that has a better safety profile than bupivacaine, is less toxic to the heart, and lasts three to six hours. Ropivacaine and lidocaine are often paired together in clinical practice. I later found that because the nociceptive nerves at the surgical site are so abundant, some patients can still feel pain even with local anesthesia. This happened mostly in cases with complex conditions, such as high anal fistulas and high and deep abscesses. In order to stop these patients from suffering, we have tried the sacral canal anesthesia method, which is effective, but the success rate is still not 100%. The most recommended method is “combined lumbar and rigid” anesthesia. This method is suitable for patients with severe disease, sensitivity and anxiety, and can last three to six hours. For more than a year, we have conducted numerous clinical trials with good results. The above-mentioned fancy anesthesia methods make anal surgery less of a burden, you just need to sleep comfortably and the surgery is done. So, don’t delay the procedure again and again because you are afraid of pain. It takes about a month for the surgical incision to grow back, but the anus still has to work every day, which is the main reason for “post-operative pain”. The key to solving this problem is what to put on the wound. Initially, we used a fentanyl patch on the wound, which was very effective for acute pain, but had the side effect of vomiting and dizziness. Later, I studied the experience handed down from experts and used long-acting painkillers in the right concentration on the wound closure, which reduced postoperative pain, especially during defecation. Ten years ago, we began to experiment with the use of targeted therapies for analgesia. We chose an analgesic called kefir, and delivered lipid microspheres containing this drug into the blood vessels by intravenous injection, that is, in the form of an infusion. The lining of a normal blood vessel is smooth, while the lining of a blood vessel damaged by surgery can be bumpy and crater-like. The lipid microspheres “fall into the pit” as the blood flows there, and then begin to release their medicinal properties. The targeted analgesia is highly targeted, and the effect is only near the wound and lasts for three to six days. The clinical response has been good for ten years. Finally, one more way to reduce pain – the analgesic pump. Have you ever seen such a patient in the anorectal ward? The patient carries a device, like a vial or a bag, which is an analgesic pump. The anesthesiologist connects a channel to the vein and delivers the analgesic drug to the body at regular intervals through the analgesic pump. The analgesic pump is able to deliver the medication into the body evenly, in low doses, and slowly, to provide pain relief throughout the body and throughout the day. This operation is very precise and is suitable for all types of patients.