Comparison of Various Analgesic Protocols for Control of Postoperative Pain Following Anorectal Surgery
Abstract
Background: Anorectal pathology is commonly perceived it and handled in common surgical practitioners’ fistula and abscess, hemorrhoids, fissures, condyloma, and other pathological conditions. Because of the strong sensory innervations of the canal of anal, patients endure severe discomfort during anorectal surgery. It is generally most severe in the first twenty-four hours especially after excisional hemorrhoidectomy. the aim of this study is a comparison between different analgesic protocols used to relieve pain postoperative anorectal surgery.
Methods: PubMed, Embase, Medline, Science Gate, Scientific Report, Elsevier, Google Scholar, and Cochrane Evidence Based Medicine Reviews were used to conduct a review search. Review of newly released books and papers with regard to the topic, as well as manual searches (Comparison of various analgesic protocols for control of postoperative pain following anorectal surgery), was started at (May,2021). we searched the published studies from 2011 to the present date by the full text:(various analgesic protocols post anorectal surgery).
Results: Anorectal surgery is marked by excruciating discomfort after the procedure. Using the new technique during anorectal surgery as hemorrhoidectomy to avoid more excision of anal mucosa and the skin, putting the suture nearest to the dentate line and away from the internal anal sphincter, and good hemostasis to avoid the inserting of the anal pack are the most essential methods to lessen pain postoperatively regardless of the type of anorectal surgery performed or the instrument to use during it. We found more protocols using multimodality pain management for the relief of pain, topical drugs that produce direct relaxation of the internal anal sphincter, topical intervention as a pudendal nerve block, a method of surgery as surgical sphincterotomy, and technical tips to reduce pain as ligasure.
Conclusion: Multimodal pain treatment has been demonstrated to minimize pain intensity and opioid doses in various kinds of surgery.
According to the highest degree of proof, using current technological procedures and tools as a ligasure with some topical agent as GTN glyceryl trinitrate ointment provided amazing excellent alleviation of postoperative pain following anorectal surgery.
[1] Gorfine SR, Onel E, Patou G, Krivokapic Z V. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: A multicenter, randomized, double-blind, placebo-controlled trial. Dis Colon Rectum. 2011; 54(12):1552–9.
[2] Leinicke JA, Carbajal V, Senders ZJ, Patil N, Wogsland A, Stein SL, et al. Opioid Prescribing Patterns After Anorectal Surgery. J Surg Res. 2020; 255:632–40.
[3] Van Backer JT, Jordan MR, Leahy DT, Moore JS, Callas P, Dominick T, et al. Preemptive analgesia decreases pain following anorectal surgery: A prospective, randomized, double-blinded, placebo-controlled trial. Dis Colon Rectum. 2018;61(7):824–9.
[4] Emile SH. Evidence-based review of methods used to reduce pain after excisional hemorrhoidectomy. J Coloproctology [Internet]. 2019; 39(1):81–9.
[5] Froehner Junior I, Kotze PG, Rocha JG, Miranda EF, Sartor MC, Martins JF, et al. Analgesia tópica com policresuleno e cinchocaína no pós-operatório de hemorroidectomias: Um estudo prospectivo e controlado. Rev Col Bras Cir. 2014;41(2):92–8.
[6] Zhang JJ, Gao HX, Zhang TT, Bao WQ, Mou JY, Meng K, et al. Pre-mixed nitrous oxide/oxygen mixture treatment of pain induced by postoperative dressing change for perianal abscess: Study protocol for a randomized, controlled trial. J Adv Nurs. 2020; 76(12):3623-30.
[7] Ceulemans A, De Looze D, Van de putte D, Stiers E, Coppens M. High post-operative pain scores despite multimodal analgesia in ambulatory anorectal surgery: a prospective cohort study. Acta Chir Belg. 2019; 119(4):224-230.
[8] Lovich-Sapola J, Smith CE, Brandt CP. Postoperative Pain Control. Surg Clin North Am. 2015; 95(2):301–18.
[9] Kunitake H, Poylin V. Complications Following Anorectal Surgery. Clin Colon Rectal Surg. 2016; 29(1):14–21.
[10] Iranpour A, Boddapati R, Vranken JH. Multimodality post proctologic surgery pain control. Semin Colon Rectal Surg. 2019; 30(4):100701.
[11] Ventham NT, O’Neill S, Johns N, Brady RR, Fearon KCH. Evaluation of novel local anesthetic wound infiltration techniques for postoperative pain following colorectal resection surgery: a meta-analysis. Dis colon rectum. 2014; 57(2):237–50.
[12] Richard III HM, Marvel RP. CT guided pudendal nerve block. Open J Radiol. 2013; 03(01):41-44.
[13] He J, Zhang L, Li DL, He WY, Xiong QM, Zheng XQ, et al. Ultrasound-Guided Pudendal Nerve Block Combined with Propofol Deep Sedation versus Spinal Anesthesia for Hemorrhoidectomy: A Prospective Randomized Study. Pain Res Manag. 2021; 2021.
[14] Rawal N. Epidural technique for postoperative pain: Gold standard no more? Reg Anesth Pain Med. 2012; 37(3):310–7.
[15] Malik S, Mirani SH, Kumar D. Effectiveness of Caudal Epidural Anaesthesia in Anorectal Surgery. Prof Med J. 2019; 26(07):1121–4.
[16] Coutaux A. Non-pharmacological treatments for pain relief: TENS and acupuncture. Jt Bone Spine. 2017; 84(6):657–61.
[17] Claydon LS, Chesterton LS, Barlas P, Sim J. Dose-specific effects of transcutaneous electrical nerve stimulation (TENS) on experimental pain: a systematic review. Clin J Pain. 2011; 27(7):635–47.
[18] Gentile M, De Rosa M, Carbone G, Pilone V, Mosella F, Forestieri P. LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial. ISRN Gastroenterol. 2011; 2011:1–6.
[19] Sarkar A, Choksi DB, Sutaria A, Sindhal M. Harmonic scalpel versus bipolar diathermy in Milligan-Morgan haemorrhoidectomy: a randomized controlled study. Int Surg J. 2018; 5(7):2507.
[20] Altomare DF, Giannini I. Pharmacological treatment of hemorrhoids: A narrative review. Expert Opin Pharmacother. 2013; 14(17):2343–9.
[21] Altomare DF, Binda GA, Canuti S, Landolfi V, Trompetto M, Villani RD. The management of patients with primary chronic anal fissure: A position paper. Tech Coloproctol. 2011; 15(2):135–41.
[22] Uzzaman MM, Siddiqui MRS. A brief literature review on the management of post-haemorrhoidectomy pain. Surg Tech Dev. 2011; 1(2):e32.
[23] Huang YJ, Chen CY, Chen RJ, Kang YN, Wei PL. Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials. Asian J Surg. 2018; 41(5):431-437.
[24] Sim H, Tan K. Randomized single‐blind clinical trial of intradermal methylene blue on pain reduction after open diathermy haemorrhoidectomy. Color Dis. 2014; 16(8):O283–7.
[25] Oz M, Lorke DE, Hasan M, Petroianu GA. Cellular and molecular actions of methylene blue in the nervous system. Med Res Rev. 2011; 31(1):93–117.
[26] Fransiska D, Jeo WS, Moenadjat Y, Friska D. Methylene Blue Effectiveness as Local Analgesic after Anorectal Surgery: A Literature Review. Adv Med. 2017; 2017:1–5.
[27] Samalavicius NE, Poskus T, Gupta RK, Lunevicius R. Long-term results of single intradermal 1% methylene blue injection for intractable idiopathic pruritus ani: a prospective study. Tech Coloproctol. 2012; 16(4):295–9.
[28] McGettigan P, Henry D. Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries. PLoS Med. 2013; 10(2):e1001388.
[29] Rahimi R, Abdollahi M. A systematic review of the topical drugs for post 64. Bou Ghanem EN, Clark S, Du X, Wu D, Camilli A, Leong JM, et al. The α-Tocopherol Form of Vitamin E Reverses Age-Associated Susceptibility to Streptococcus pneumoniae Lung Infection by Modulating Pulmonary Neutrophil Recruitment. J Immunol. 2015; 194(3):1090–9.
[30] Ruiz-Tovar J, Garcia A, Ferrigni C, Duran M. Application of Vitamin E Acetate on Staple Lines and Anastomoses of Roux-en-Y Gastric Bypass: Impact on Postoperative Pain and Acute Phase Reactants. Obes Surg. 2020; 30(8):2988–93.
[31] Ala S, Alvandipour M, Saeedi M, Seyedein S, Monajati M, Koulaeinejad N. Evaluation of Cholestyramine 15% Ointment in Relieving Pruritus and Burning After Ileostomy: A Rrandomized, Double-Blind Placebo-Controlled Clinical Trial. J Investig Surg. 2020;33(9):795–802.
[32] Whitehead RA, Puil E, Ries CR, Schwarz SKW, Wall RA, Cooke JE, et al. GABAB receptor-mediated selective peripheral analgesia by the non-proteinogenic amino acid, isovaline. Neuroscience. 2012; 213:154–60.
[33] Nemeth BA, Montero RJ, Halanski MA, Noonan KJ. Epidural baclofen for the management of postoperative pain in children with cerebral palsy. J Pediatr Orthop. 2015; 35(6):571–5.
[34] Ala S, Saeedi M, Eshghi F, Rafati M, Hejazi V, Hadianamrei R. Efficacy of 10 % sucralfate ointment in the reduction of acute postoperative pain after open hemorrhoidectomy: A prospective, double-blind, randomized, placebo-controlled trial. World J Surg. 2013;37(1):233–8.
[35] Uzzaman MM, Siddiqui MRS. A brief literature review on the management of post-haemorrhoidectomy pain. Surg Tech Dev. 2011; 1(2):e32.
[36] Solorio-López S, Palomares-Chacón UR, Guerrero-Tarín JE, González-Ojeda A, Cortés-Lares JA, Rendón-Félix J, et al. Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial. Rev Esp Enfermedades Dig. 2015; 107(11):681-5.
[37] Iranpour A, Boddapati R. Multimodality post proctologic surgery pain control. In: Seminars in Colon and Rectal Surgery. Elsevier; 2019. p. 100701.
[38] Honca M, Dereli N, Kose EA, Honca T, Kutuk S, Unal SS, et al. Low-dose levobupivacaine plus fentanyl combination for spinal anesthesia in anorectal surgery. Braz J Anesthesiol. 2015; 65(6):461-5.
[39] Shim SM, Park JH, Hyun DM, Jeong EK, Kim SS, Lee HM. The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia. Korean J Anesthesiol. 2018;71(3):213–9.
[40] Gandhi K, Baratta JL, Heitz JW, Schwenk ES, Vaghari B, Viscusi ER. Acute pain management in the postanesthesia care unit. Anesthesiol Clin. 2012; 30(3):e1–15.
[41] Periodicals W. Does Ketamine Improve Postoperative Analgesia ? More Questions Than Answers. 2011;1135–6.
[42] Casale R, Symeonidou Z, Bartolo M. Topical Treatments for Localized Neuropathic Pain. Curr Pain Headache Rep. 2017;21(3):15.
[43] Kazemeini A, Rahimi M, Fazeli MS, Mirjafari SA, Ghaderi H, Fani K, et al. The effect of local injections of bupivacaine plus ketamine, bupivacaine alone, and placebo on reducing postoperative anal fistula pain: A randomized clinical trial. Sci World J. 2014; 2014:4–9.
[44] Farooq AS, Ahmed S, Javed MR, Rizwan S, Asif M, Khan RH. Comparison of Hemorrhoidectomy alone Vs Hemorrhoidectomy with Lateral Sphincterotomy in Terms of Post-Operative Pain Relief. Hemorrhoidectomy alone Vs Hemorrhoidectomy. 2019; 13(4):283-6.
[45] DK Das U. Effectiveness of Internal Sphincterotomy in reducing Post Open Hemorrhoidectomy Pain: A Randomized Comparative Clinical Study. Int J Collab Res Intern Med Public Heal. 2013; 5(6):428–35.
[2] Leinicke JA, Carbajal V, Senders ZJ, Patil N, Wogsland A, Stein SL, et al. Opioid Prescribing Patterns After Anorectal Surgery. J Surg Res. 2020; 255:632–40.
[3] Van Backer JT, Jordan MR, Leahy DT, Moore JS, Callas P, Dominick T, et al. Preemptive analgesia decreases pain following anorectal surgery: A prospective, randomized, double-blinded, placebo-controlled trial. Dis Colon Rectum. 2018;61(7):824–9.
[4] Emile SH. Evidence-based review of methods used to reduce pain after excisional hemorrhoidectomy. J Coloproctology [Internet]. 2019; 39(1):81–9.
[5] Froehner Junior I, Kotze PG, Rocha JG, Miranda EF, Sartor MC, Martins JF, et al. Analgesia tópica com policresuleno e cinchocaína no pós-operatório de hemorroidectomias: Um estudo prospectivo e controlado. Rev Col Bras Cir. 2014;41(2):92–8.
[6] Zhang JJ, Gao HX, Zhang TT, Bao WQ, Mou JY, Meng K, et al. Pre-mixed nitrous oxide/oxygen mixture treatment of pain induced by postoperative dressing change for perianal abscess: Study protocol for a randomized, controlled trial. J Adv Nurs. 2020; 76(12):3623-30.
[7] Ceulemans A, De Looze D, Van de putte D, Stiers E, Coppens M. High post-operative pain scores despite multimodal analgesia in ambulatory anorectal surgery: a prospective cohort study. Acta Chir Belg. 2019; 119(4):224-230.
[8] Lovich-Sapola J, Smith CE, Brandt CP. Postoperative Pain Control. Surg Clin North Am. 2015; 95(2):301–18.
[9] Kunitake H, Poylin V. Complications Following Anorectal Surgery. Clin Colon Rectal Surg. 2016; 29(1):14–21.
[10] Iranpour A, Boddapati R, Vranken JH. Multimodality post proctologic surgery pain control. Semin Colon Rectal Surg. 2019; 30(4):100701.
[11] Ventham NT, O’Neill S, Johns N, Brady RR, Fearon KCH. Evaluation of novel local anesthetic wound infiltration techniques for postoperative pain following colorectal resection surgery: a meta-analysis. Dis colon rectum. 2014; 57(2):237–50.
[12] Richard III HM, Marvel RP. CT guided pudendal nerve block. Open J Radiol. 2013; 03(01):41-44.
[13] He J, Zhang L, Li DL, He WY, Xiong QM, Zheng XQ, et al. Ultrasound-Guided Pudendal Nerve Block Combined with Propofol Deep Sedation versus Spinal Anesthesia for Hemorrhoidectomy: A Prospective Randomized Study. Pain Res Manag. 2021; 2021.
[14] Rawal N. Epidural technique for postoperative pain: Gold standard no more? Reg Anesth Pain Med. 2012; 37(3):310–7.
[15] Malik S, Mirani SH, Kumar D. Effectiveness of Caudal Epidural Anaesthesia in Anorectal Surgery. Prof Med J. 2019; 26(07):1121–4.
[16] Coutaux A. Non-pharmacological treatments for pain relief: TENS and acupuncture. Jt Bone Spine. 2017; 84(6):657–61.
[17] Claydon LS, Chesterton LS, Barlas P, Sim J. Dose-specific effects of transcutaneous electrical nerve stimulation (TENS) on experimental pain: a systematic review. Clin J Pain. 2011; 27(7):635–47.
[18] Gentile M, De Rosa M, Carbone G, Pilone V, Mosella F, Forestieri P. LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial. ISRN Gastroenterol. 2011; 2011:1–6.
[19] Sarkar A, Choksi DB, Sutaria A, Sindhal M. Harmonic scalpel versus bipolar diathermy in Milligan-Morgan haemorrhoidectomy: a randomized controlled study. Int Surg J. 2018; 5(7):2507.
[20] Altomare DF, Giannini I. Pharmacological treatment of hemorrhoids: A narrative review. Expert Opin Pharmacother. 2013; 14(17):2343–9.
[21] Altomare DF, Binda GA, Canuti S, Landolfi V, Trompetto M, Villani RD. The management of patients with primary chronic anal fissure: A position paper. Tech Coloproctol. 2011; 15(2):135–41.
[22] Uzzaman MM, Siddiqui MRS. A brief literature review on the management of post-haemorrhoidectomy pain. Surg Tech Dev. 2011; 1(2):e32.
[23] Huang YJ, Chen CY, Chen RJ, Kang YN, Wei PL. Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials. Asian J Surg. 2018; 41(5):431-437.
[24] Sim H, Tan K. Randomized single‐blind clinical trial of intradermal methylene blue on pain reduction after open diathermy haemorrhoidectomy. Color Dis. 2014; 16(8):O283–7.
[25] Oz M, Lorke DE, Hasan M, Petroianu GA. Cellular and molecular actions of methylene blue in the nervous system. Med Res Rev. 2011; 31(1):93–117.
[26] Fransiska D, Jeo WS, Moenadjat Y, Friska D. Methylene Blue Effectiveness as Local Analgesic after Anorectal Surgery: A Literature Review. Adv Med. 2017; 2017:1–5.
[27] Samalavicius NE, Poskus T, Gupta RK, Lunevicius R. Long-term results of single intradermal 1% methylene blue injection for intractable idiopathic pruritus ani: a prospective study. Tech Coloproctol. 2012; 16(4):295–9.
[28] McGettigan P, Henry D. Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries. PLoS Med. 2013; 10(2):e1001388.
[29] Rahimi R, Abdollahi M. A systematic review of the topical drugs for post 64. Bou Ghanem EN, Clark S, Du X, Wu D, Camilli A, Leong JM, et al. The α-Tocopherol Form of Vitamin E Reverses Age-Associated Susceptibility to Streptococcus pneumoniae Lung Infection by Modulating Pulmonary Neutrophil Recruitment. J Immunol. 2015; 194(3):1090–9.
[30] Ruiz-Tovar J, Garcia A, Ferrigni C, Duran M. Application of Vitamin E Acetate on Staple Lines and Anastomoses of Roux-en-Y Gastric Bypass: Impact on Postoperative Pain and Acute Phase Reactants. Obes Surg. 2020; 30(8):2988–93.
[31] Ala S, Alvandipour M, Saeedi M, Seyedein S, Monajati M, Koulaeinejad N. Evaluation of Cholestyramine 15% Ointment in Relieving Pruritus and Burning After Ileostomy: A Rrandomized, Double-Blind Placebo-Controlled Clinical Trial. J Investig Surg. 2020;33(9):795–802.
[32] Whitehead RA, Puil E, Ries CR, Schwarz SKW, Wall RA, Cooke JE, et al. GABAB receptor-mediated selective peripheral analgesia by the non-proteinogenic amino acid, isovaline. Neuroscience. 2012; 213:154–60.
[33] Nemeth BA, Montero RJ, Halanski MA, Noonan KJ. Epidural baclofen for the management of postoperative pain in children with cerebral palsy. J Pediatr Orthop. 2015; 35(6):571–5.
[34] Ala S, Saeedi M, Eshghi F, Rafati M, Hejazi V, Hadianamrei R. Efficacy of 10 % sucralfate ointment in the reduction of acute postoperative pain after open hemorrhoidectomy: A prospective, double-blind, randomized, placebo-controlled trial. World J Surg. 2013;37(1):233–8.
[35] Uzzaman MM, Siddiqui MRS. A brief literature review on the management of post-haemorrhoidectomy pain. Surg Tech Dev. 2011; 1(2):e32.
[36] Solorio-López S, Palomares-Chacón UR, Guerrero-Tarín JE, González-Ojeda A, Cortés-Lares JA, Rendón-Félix J, et al. Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial. Rev Esp Enfermedades Dig. 2015; 107(11):681-5.
[37] Iranpour A, Boddapati R. Multimodality post proctologic surgery pain control. In: Seminars in Colon and Rectal Surgery. Elsevier; 2019. p. 100701.
[38] Honca M, Dereli N, Kose EA, Honca T, Kutuk S, Unal SS, et al. Low-dose levobupivacaine plus fentanyl combination for spinal anesthesia in anorectal surgery. Braz J Anesthesiol. 2015; 65(6):461-5.
[39] Shim SM, Park JH, Hyun DM, Jeong EK, Kim SS, Lee HM. The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia. Korean J Anesthesiol. 2018;71(3):213–9.
[40] Gandhi K, Baratta JL, Heitz JW, Schwenk ES, Vaghari B, Viscusi ER. Acute pain management in the postanesthesia care unit. Anesthesiol Clin. 2012; 30(3):e1–15.
[41] Periodicals W. Does Ketamine Improve Postoperative Analgesia ? More Questions Than Answers. 2011;1135–6.
[42] Casale R, Symeonidou Z, Bartolo M. Topical Treatments for Localized Neuropathic Pain. Curr Pain Headache Rep. 2017;21(3):15.
[43] Kazemeini A, Rahimi M, Fazeli MS, Mirjafari SA, Ghaderi H, Fani K, et al. The effect of local injections of bupivacaine plus ketamine, bupivacaine alone, and placebo on reducing postoperative anal fistula pain: A randomized clinical trial. Sci World J. 2014; 2014:4–9.
[44] Farooq AS, Ahmed S, Javed MR, Rizwan S, Asif M, Khan RH. Comparison of Hemorrhoidectomy alone Vs Hemorrhoidectomy with Lateral Sphincterotomy in Terms of Post-Operative Pain Relief. Hemorrhoidectomy alone Vs Hemorrhoidectomy. 2019; 13(4):283-6.
[45] DK Das U. Effectiveness of Internal Sphincterotomy in reducing Post Open Hemorrhoidectomy Pain: A Randomized Comparative Clinical Study. Int J Collab Res Intern Med Public Heal. 2013; 5(6):428–35.
| Files | ||
| Issue | Vol 8 No 3 (2022): Summer |
|
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v8i3.9618 | |
| Keywords | ||
| Analgesic Pain Surgery | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Rahimi M, Shamsi A, Hasan A. Comparison of Various Analgesic Protocols for Control of Postoperative Pain Following Anorectal Surgery. Arch Anesth & Crit Care. 2022;8(3):240-247.
