The Effect of Perianal Tramadol Infiltration on Postoperative Pain Following Hemorrhoidectomy

Abstract

Introduction The present study was attempted to evaluate the effect of perianal infiltration of tramadol on postoperative pain in patients undergoing hemorrhoidectomy. Method This double-blind clinical trial study was carried out on 90 patients with grade 3 and 4 hemorrhoids undergoing hemorrhoidectomy. Patients were randomly assigned into 3 groups of control or bupivacaine or tramadol. Before the surgery, perianal infiltration of .25% bupivacaine or tramadol or normal saline was prescribed to each group, respectively. Data on pain severity (based on the visual analog scale (VAS), the duration of surgery, sedation score, pain at the first defecation, first request time for additional analgesia, nausea and vomiting, and analgesic intakes) were evaluated and analyzed. Results Duration of surgery was almost similar in all 3 groups ( P = .974). The results showed a significant difference in pain score between 3 groups ( P ≤.05) at all times after the surgery. In addition, the means of sedation scores ( P = .03), pain score at the first defecation ( P = .001), the time to first analgesic request ( P = .001), and ketorolac administration times ( P = .01) were significantly different between 3 groups. Finally, no complication was reported regarding postoperative nausea and vomiting. Conclusion Given the notable efficacy of tramadol in reducing pain after hemorrhoidectomy and its minor side effects, this medication is suggested as an effective topical anesthetic to decrease pain after 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 .…”

“…Bupivacaine is a long-term local anesthetic drug that provides non-opioid analgesic effects by inhibiting the initiation and transmission of nerve impulses ( Farag and Esmat, 2016 ; Chitty et al, 2022 ). Previous studies have reported the analgesic effect and safety of bupivacaine in patients undergoing hemorrhoidectomy ( Hatami et al, 2022 ; Steen et al, 2022 ), while some limitations existed in the individual original studies, such as smaller sample size or performed in only one region. The meta-analysis could combine the results of two or more individual studies and demonstrate a good evidence advantage.…”

“…Like other local anesthetics, bupivacaine exerts its effect by inhibiting the initiation and conduction of nerve impulses, providing a non-opioid analgesic effect ( Chitty et al, 2022 ). Previous studies have reported the analgesic effect of bupivacaine in patients undergoing hemorrhoidectomy ( Hatami et al, 2022 ; Steen et al, 2022 ). Hatami et al (2022) reported that the pain level was lower in the bupivacaine group than in the placebo group at 2 h, 4 h, 8 h, 12 h, and 24 h after hemorrhoidectomy in patients with grade III and IV hemorrhoids.…”

“…Previous studies have reported the analgesic effect of bupivacaine in patients undergoing hemorrhoidectomy ( Hatami et al, 2022 ; Steen et al, 2022 ). Hatami et al (2022) reported that the pain level was lower in the bupivacaine group than in the placebo group at 2 h, 4 h, 8 h, 12 h, and 24 h after hemorrhoidectomy in patients with grade III and IV hemorrhoids. Steen et al (2022) reported that bupivacaine reduced the pain level of patients with symptomatic hemorrhoids after hemorrhoidectomy.…”

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review

“…Reviewing the literature, the physio pathological background for the pain seems to be the reflex contraction of the internal anal sphincter, regarding the surgical trauma, a contraction that outlasts the pain-free interval that spinal anesthesia offers. Therefore, the use of long-lasting local anesthetics (LA), such as Bupivacaine or Tetracaine, is highly recommended by some authors[ 8 - 13 ]. However, our experience differs, as in our study, where surgeries were performed under spinal anesthesia (SA) with Marcaine (0.5% Bupivacaine), since the standard OH can be done in a 30-40 min timeframe, administering a long-lasting LA at the end of the procedure would overlap the pain free interval by almost 90% of the SA, leaving just about 30 minutes, on average, of supplementary protection against pain.…”