Effectiveness of Topical Ketorolac in Post-hemorrhoidectomy Pain Management: A Clinical Trial

Abstract

Background: Postoperative pain management is one of the major challenges of surgeons and anesthesiologists. Objectives: This study aimed to determine the efficacy of topical ketorolac in post-hemorrhoidectomy pain management. Methods: This clinical trial was conducted on 84 candidates for hemorrhoidectomy (grade-II hemorrhoids) who visited Ali ibn Abi-Talib hospital of Rafsanjan, Kerman, Iran (2020 - 2021). The participants were selected through convenience sampling and randomly assigned to three groups of 28. The subjects were treated in topical (4 mL 0.5% Marcaine + 1 mL ketorolac at the surgical site), intramuscular (4 mL 0.5% Marcaine at the surgical site + 1 mL ketorolac intramuscularly), and control (4 mL 0.5% Marcaine at the surgical site) groups. Pain intensity was measured using the Numerical Pain Rating Scale 1, 6, 12, and 24 hours after surgery. The obtained data were analyzed using two-way repeated measures analysis of variance. Results: Female and male patients constituted 46.4% and 53.6% of the participants, respectively. The mean pain intensity was significantly lower in the topical group than in intramuscular and control treatments in all four stages of pain assessment (P < 0.001). Some participants were treated with pethidine due to high pain intensity. However, the mean pain intensity gradually reduced over time in all three groups. Conclusions: Study findings suggested that the topical administration of ketorolac and Marcaine was more effective than Marcaine used alone for relieving pain in patients undergoing hemorrhoidectomy.

The effect of bupivacaine on analgesia and safety in patients undergoing hemorrhoidectomy: a meta-analysis

“…Furthermore, 65 irrelevant studies and 1 non-English study were excluded based on full-text reading. Finally, 18 eligible studies were included in our meta-analysis ( Jirasiritham et al, 2004 ; Naja et al, 2005 ; Ng et al, 2006 ; Imbelloni et al, 2007 ; Gorfine et al, 2011 ; Haas et al, 2012 ; Rajabi et al, 2012 ; Moreira et al, 2014 ; Sim and Tan, 2014 ; Farag and Esmat, 2016 ; Shashikala and Prathibha, 2016 ; Ruiz-Castro et al, 2017 ; Chitty et al, 2022 ; Cui et al, 2022 ; Hatami et al, 2022 ; Medina-Gallardo et al, 2022 ; Steen et al, 2022 ; Shahrokhzadeh et al, 2023 ). The characteristics of the 18 eligible studies are shown in Table 1 .…”

“…In addition, the present meta-analysis found that the bupivacaine-combined other drug group had a lower postoperative pain level at 6 h, 12 h, and 24 h compared to the bupivacaine group. In the included studies reporting these three outcomes, the other drugs were defined as ketorolac, morphine, and metronidazole ( Ng et al, 2006 ; Moreira et al, 2014 ; Shahrokhzadeh et al, 2023 ). The reason for our finding may be that a combination with other drugs may strengthen the initial anesthetic effect of bupivacaine, thereby providing longer postoperative pain control ( Ng et al, 2006 ; Moreira et al, 2014 ; Shahrokhzadeh et al, 2023 ).…”