Evidence-based management of pain after haemorrhoidectomy surgery

Joshi, Girish P.; Neugebauer, Edmund

doi:10.1002/bjs.7161

Cited by 101 publications

(80 citation statements)

References 82 publications

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“…19 Additional examples where rA was neglected included open reconstruction of knee ligaments (rank, 15) and hemorrhoid resections with plastic reconstruction (rank, 23), which are both known to be painful procedures. Although randomized controlled trials (rCTs) have demonstrated clinically significant pain reduction after femoral nerve blocks 25 and wound infiltration with local anesthesia, 26 in our study population these techniques were hardly ever used.…”

Section: Discussionmentioning

confidence: 99%

Pain Intensity on the First Day after Surgery

et al. 2013

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Background: Severe pain after surgery remains a major problem, occurring in 20-40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedurespecific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified. Methods: This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0-10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared. Results: The 40 procedures with the highest pain scores (median numeric rating scale, 6-7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many "minor" surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of "major"

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Section: Discussionmentioning

confidence: 99%

Pain Intensity on the First Day after Surgery

et al. 2013

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“…The grave problem about the conventional hemorrhoidectomies is the postoperative pain starting just after the operation and still exists as a major issue, even though the procedure is considered to be an old intervention. This aspect has been analyzed in several studies, as the hemorrhoidectomy is a procedure in which the severe pain necessitating opioid drugs in analgesic management occurs in 20-40% of patients [11,12].…”

Section: Discussionmentioning

confidence: 99%

Geleneksel diyatermi ile kıyaslandığında harmonik bistürinin hemoroidektomide faydası var mıdır?

Dogan

Dönmez

Akturk

et al. 2018

Archives of Clinical and Experimental Medicine

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Aim: Symptomatic hemorrhoidal disease is among the most common surgical diseases and it may necessitate surgical intervention. The most common and effective approaches used for surgical treatment are harmonic scalpel hemorrhoidectomy and conventional diathermy excision. The aim of the study was to compare the outcomes of hemorrhoidectomy using harmonic scalpel and the conventional diathermy excision techniques. Methods: The files of 113 consecutively operated patients (26 females 23%, 87 males 77%), who were operated on for symptomatic Grade III-IV hemorrhoids, were retrospectively reviewed for length of operation and hospitalization, early and delayed bleeding, urinary retention, postoperative abscess and anal stenosis. Exclusion criteria were additional operations, recurrent cases and inflammatory bowel disease. Results: Conventional diathermy hemorrhoidectomy in 60 (53%) and harmonic scalpel hemorrhoidectomy were used in 53 patients (47%). There were significant differences between the operation and hospitalization times in favor of harmonic scalpel group (p<0.05 for both). The other parameters did not show any significant differences (p>0.05 for all). Conclusion: Harmonic scalpel hemorrhoidectomy is advantageous and superior to conventional diathermy hemorrhoidectomy in regard to shorter operation time and earlier discharge from the hospital with no additonal complications. Keywords: Harmonic, Hemorrhoidectomy, Scalpel, Surgery, Technique Öz Amaç: Semptomatik hemoroidal hastalık, en yaygın cerrahi hastalıklar arasındadır ve tedavide cerrahi müdahale gerekebilir. Cerrahi tedavide etkili yaklaşımlar harmonik bistüri ile hemoroidektomi ve konvansiyonel diyatermi ile eksizyondur. Çalışmanın amacı, harmonik bistüri ve konvansiyonel diyatermi eksizyon teknikleriyle yapılan hemoroidektomi sonuçlarını karşılaştırmaktı. Yöntemler: Semptomatik Evre III-IV hemoroid nedeniyle ardışık operasyon yapılan 113 hasta (26 kadın, % 23; 87 erkek, % 77) dosyaları retrospektif olarak incelendi ve operasyon ve hastanede kalış süresi, erken ve gecikmiş kanama, idrar yapmada zorluk, postoperatif apse ve anal stenoz araştırıldı. Dışlama kriterleri; ek cerrahi uygulanması, rekürren vakalar ve inflamatuvar bağırsak hastalığı idi. Bulgular: Altmış hastada (%53) konvansiyonel diyatermi ile hemoroidektomi ve 53 hastada (%47) harmonik bistüri ile hemoroidektomi uygulandı. Operasyon ve yatış süreleri arasında harmonik bistüri grubu lehine anlamlı farklılık tespit edildi (her ikisi için p<0,05). Diğer parametrelerde anlamlı bir farklılık yoktu (hepsi için p>0,05). Sonuç: Harmonik bistüri ile hemoroidektomi, ameliyat süresinin kısa olması ve hastaneden daha erken taburcu olmasına karşın ek bir komplikasyona rastlanmadığı için konvansiyonel diyatermi hemoroidektomisine göre avantajlıdır.

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“…The consensus is that the aetiology of haemorrhoids is multi-factorial and can be analysed from the point of view of the complex anal structure and function (Gan et al, 2010;Joshi and Neugebauer, 2010): The anus is the excretory outlet for faeces which are composed mainly of bacteria. It frequently sustains injuries such as rupture by hardened stool or abrasion by sanitary tissues.…”

Section: Discussionmentioning

confidence: 99%

A randomized, double-blind, placebo-controlled trial of a Chinese herbal <i>Sophora</i> flower formula in patients with symptomatic haemorrhoids: A preliminary study

Man¹,

Chen²,

Wang³

et al. 2013

Afr. J. Trad. Compl. Alt. Med.

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Dried flowers and buds of Sophora japonica (Huaihua) are used in China, Japan and Korea for treating haematemesis and bleeding haemorrhoids. This study compared the clinical safety and efficacy of a Sophora flower formula with a placebo for the conservative treatment of symptomatic haemorrhoids. The study was a prospective, double-blind, randomized placebo-controlled trial. The clinical effective rate, symptom score and the incidence of important clinical events were used as observation indices to evaluate the effect of the Sophora flower formula. The results showed that after 7 days of treatment, improvement was observed in 87.0% of the patients' major symptoms in the Sophora flower formula group compared with 81.8% of those in the placebo group. After 14 days, 78.2% patients in the Sophora flower formula group were asymptomatic, whereas 40.9% of those in the placebo group exhibited residual symptoms. However, the difference between both groups was not statistically significant. As the bowel habits of the patients improved and as the patients took sitz baths, their symptoms improved drastically, regardless of the use of the Sophora flower formula. These findings indicate that the traditional Chinese Sophora flower formula is clinically safe; however, its effects on haemorrhoids need to be studied in a larger sample size and with different dosages. The present study results may be a potential clinical reference for physicians prescribing medications for patients with symptomatic haemorrhoids.

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Evidence-based management of pain after haemorrhoidectomy surgery

Abstract: Local anaesthetic infiltration, either as a sole technique or as an adjunct to general or regional anaesthesia, and combinations of analgesics (non-steroidal anti-inflammatory drugs, paracetamol and opiates) are recommended. If appropriate, a stapled operation may be preferable.

Cited by 101 publications

References 82 publications

Pain Intensity on the First Day after Surgery

Pain Intensity on the First Day after Surgery

Geleneksel diyatermi ile kıyaslandığında harmonik bistürinin hemoroidektomide faydası var mıdır?

A randomized, double-blind, placebo-controlled trial of a Chinese herbal <i>Sophora</i> flower formula in patients with symptomatic haemorrhoids: A preliminary study

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