Abstract
Background Postoperative pain is a major adverse effect of surgery for mixed hemorrhoids. We evaluated whether spinal anesthesia with ropivacaine and hydromorphone provided safe and effective analgesia after surgery for mixed hemorrhoids. Methods This single-center, double-blind pilot study included patients with mixed hemorrhoids who underwent a procedure for prolapse and hemorrhoids (PPH) and external hemorrhoidectomy under spinal anesthesia at Zhejiang Hospital, China (October 2020 to December 2020). Patients were randomized to a hydromorphone group (spinal anesthesia with 0.5% ropivacaine and 75 μg hydromorphone) or morphine group (spinal anesthesia with 0.5% ropivacaine and 150 μg morphine). Pain scores (numerical rating scale), incidences of vomiting and itching, and length of hospital stay (LoS) were recorded at 6, 12, 18, and 24 hours after surgery. Results The analysis included 40 patients in each group. Median (interquartile range) pain score in the hydromorphone group was higher than that in the morphine group at 12 hours (1 (0–2] vs. 0 (0–2), p=0.044) but not significantly different between groups at 6 hours (0 (0–1) vs. 0 (0-0) p=0.228), 18 hours (2 (2–3) vs. 2 (1–3) p=0.060) or 24 hours (2 (2–3) vs. 2 (1–3) p=0.081). The hydromorphone group had a lower incidence of pruritus than the morphine group (47.5% vs. 67.5%, p=0.018). There were no significant differences between groups in vomiting incidence or LoS. Conclusion In patients with mixed hemorrhoids, spinal anesthesia with ropivacaine/hydromorphone has a comparable analgesic effect and a lower incidence of pruritus during the first 24 hours after surgery than spinal anesthesia with ropivacaine/morphine.
Highlights
Spinal anesthesia with morphine and local anesthetics is often used as a component of multimodal analgesia for lower abdominal surgery such as cesarean section and prostatectomy [11, 12]
Patients with mixed hemorrhoids scheduled to undergo a procedure for prolapse and hemorrhoids (PPH) and external hemorrhoidectomy at Zhejiang Hospital between October 2020 and December 2020 were enrolled consecutively. e inclusion criteria were 18–60 years old, diagnosed with mixed hemorrhoids, American Association of Anesthesiologists (ASA) class I or II, and scheduled for PPH and external hemorrhoidectomy under spinal anesthesia. e exclusion criteria included the following: history of opioid abuse, long-term use of opioids due to chronic pain, and failure of lumbar anesthesia necessitating a switch to another method of anesthesia. e withdrawal criteria were not followed up after surgery, and a patient withdrew his consent
An important finding of the present study was that spinal anesthesia with hydromorphone and ropivacaine provided a comparable analgesic effect to spinal anesthesia with morphine and ropivacaine, with both methods achieving a good level of analgesia according to the numerical rating scale (NRS) pain scores
Summary
Hemorrhoid disease is very common, affecting 11% of people worldwide [1]. Patients with mixed hemorrhoids have both internal hemorrhoids (which lie above the dentate line and show varying degrees of prolapse) and external hemorrhoids (which are located below the dentate line and can undergo thrombosis) [2]. The anorectal and perianal regions are sensitive areas, and most perianal operations, including surgery for mixed hemorrhoids, cause severe postoperative pain [3, 5–7]. Many patients still experience substantial postoperative pain after anorectal surgery despite the use of multimodal analgesia [10]. Postoperative pain is a major adverse effect of surgery for mixed hemorrhoids. We evaluated whether spinal anesthesia with ropivacaine and hydromorphone provided safe and effective analgesia after surgery for mixed hemorrhoids. Is single-center, double-blind pilot study included patients with mixed hemorrhoids who underwent a procedure for prolapse and hemorrhoids (PPH) and external hemorrhoidectomy under spinal anesthesia at Zhejiang Hospital, China (October 2020 to December 2020). In patients with mixed hemorrhoids, spinal anesthesia with ropivacaine/hydromorphone has a comparable analgesic effect and a lower incidence of pruritus during the first 24 hours after surgery than spinal anesthesia with ropivacaine/morphine
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