The problem of pain after day-surgery haemorrhoidectomy

A total of 185 patients underwent day surgery haemorrhoidectomy with postoperative discharge after 24 h. An open technique (Milligan-Morgan) was adopted in 177 cases (97.8%) and a closed technique (Ferguson) in 8 cases (2.2%). In all cases, anaesthesia was achieved by the posterior perineal block: effective analgesia was obtained in 52.4% of the cases (very good and good analgesia) and postoperative analgesic effectiveness reached 5–10 h in most patients (49.2%), while in 9.2% of the cases analgesia was effective for up to 15 h or over. Innervation complexity and early wound stimulation make a painless haemorrhoidectomy impossible. It was not found that any particular surgical technique was superior to another. No evident advantages could be found in closed haemorrhoidectomies or laser/diathermic dissection nor was routine internal sphincterotomy found useful. Pain control was mainly entrusted to the action of pharmaceutical agents. In the operating theatre, the posterior perineal block can be followed by long term local anaesthetic or NSAIDs infiltration of muco-cutaneous wounds. During the postoperative period, lasting 30 days, pain assessment is not an easy task but this can be performed by Graphic Rating Scale. Pain at rest was moderate to acute during week 1 in 64.3% of the cases, while being light or absent in 35.7%. By week 2, pain had become moderate to acute in 29.2% of the patients, being light or absent in 70.8%. Finally, by week 3, only 10.8% of the patients reported moderate to acute pain (and this was due to complications ensuing such as haemorrhage or stenosis). Pain intensity increased at defecation, with 86% of the patients reporting acute moderate pain in week 1. A more gradual reduction of pain at evacuation was noted in later weeks compared to that at rest. Only in 2.7% of the cases did we have to resort to major analgesia during the first 24 h. In all other cases, NSAIDs (Ketorolac) sufficed with i.m. injections of 30 mg up to three times a day before discharge and 10 mg orally up to three times a day once the patient had returned home. Effective anaesthesia, competent surgery, a close follow up and regularly administered minor analgesics provide effective postoperative pain control after day surgery haemorrhoidectomy. As a result, the operation is no longer feared, as next to normal physical activity was reported towards the end of week 1 in 94.1% of the cases. Most patients expressed full satisfaction with their treatment 30 days after surgery. © 1998 Elsevier Science B.V. All rights reserved.