Multimodal long-acting analgesia after hemorrhoidectomy based on ERAS concept: a randomized, single-blind clinical study

BACKGROUND: Effective postoperative pain control is helpful for enhanced recovery after surgery(ERAS). ERAS guidelines recommend multimodal postoperative analgesia protocols after a colorectal operation. We recombined the current commonly used postoperative analgesia of hemorrhoids to develop two groups of multimodal long-acting analgesia protocols compared with a non-long-acting analgesia protocol. A single-blind controlled clinical study was designed to observe the efficacy and safety of the regimens.METHODS: A total of 90 patients were enrolled, patients selected different analgesic methods for wound area according to different groups after surgery. 30 patients received multimodal long-acting analgesia protocol A, including caudal anesthesia, methylene blue application and lidocaine injection to the wound; 30 patients received multimodal long-acting analgesia protocol B, only methylene blue application to the wound; 30 patients received multimodal non-long-acting analgesia protocol C, only lidocaine injection to the wound. In addition, all three groups received lidocaine caudal anesthesia and intravenous parecoxib. We conducted a randomized, single-blind clinical study to evaluate the efficacy of three analgesic programs by VAS scores of resting pain, exercise pain, defecation pain, dressing change pain, BCS comfort score, nausea and vomiting, uroschesis, anus function, anus edema, and opioid saving.RESULTS: VAS scores of postoperative resting pain and exercise pain in groups A and B at 24h, 48h, and 3d. VAS scores of postoperative dressing change pain and defecation pain in the first three times were lower than those in group C. BCS scores of groups A and B were higher than those of group C at 24h,48h, and 3d. Compared with group C, groups A and B had less additional opioid dosage and a lower incidence of nausea and vomiting (P<0.05). There was no statistical difference in all therapeutic indexes between groups A and B (P>0.05), and no significant difference in the score of anal edema and uroschesis among the three groups (P>0.05). The anal function of patients in the three groups was normal, and no anal incontinence occurred.CONCLUSIONS: The two regimens of multimodal long-acting analgesia showed obvious advantages in pain management, especially in the first three days after hemorrhoidectomy. At the same time, the use of opioids is less and the incidence of adverse reactions of nausea and vomiting is lower in the long-acting analgesia groups. However, the medication of protocol B was more simplified than A, therefore we recommend multimodal long-acting analgesia protocol B may be more suitable for clinical application.