PUSHES (Pudendal Block Versus Sacral ESP Hemorrhoidectomy Study)

Inclusion Criteria: * Adults (≥18 years old) scheduled for elective excisional hemorrhoidectomy; * Ability to understand the nature of the study and provide written informed consent; * American Society of Anesthesiologists (ASA) physical status I-III; * Ability to comply with study procedures and postoperative evaluations. Exclusion Criteria: * Pregnancy; * Body weight under 50 kg due to the potential risk of local anaesthetic systemic toxicity (LAST); * BMI \> 40; Known allergy or contraindication to local anaesthetics (e.g., ropivacaine, prilocaine); * Severe coagulation disorders or current anticoagulant therapy contraindicating spinal or peripheral deep nerve blocks (like pudendal block, because Sacral ESP is considered a superficial block); * Infection at the puncture site; * Neurological disorders affecting the sacral or pudendal nerve pathways; * Severe psychiatric conditions impairing study participation; * Language barriers