Ortiz PRJO, Orozco OP, Mervitch SN, Hurtado RC

Language: Spanish
References: 9
Page: 149-152
PDF size: 60.25 Kb.

ABSTRACT

Objective: To evaluate the advantages and feasibility of multimodal analgesia in hemorrhoidectomy patients (ptes) with posterior perianal block with bupivacaine 0.5%, and the use of COX₂ inhibitors as the only analgesic drugs, combined with physical methods (hydrotherapy). Methods: From July 2002 to May 2003 we performed 60 consecutively hemorrhoidectomies with general anesthesia in an overnight stay regimen in our ambulatory surgical department. Posterior perianal block involves infiltration of the inferior hemorrhoidal nerves and the posterior branch of the internal pudendal nerves, with de use of COX₂ inhibitors for 10 days and diclofenaco 0.75 mg (only 1 dose), and the use of physical methods (hydro-therapy). Postoperatively pain was assessed on a visual analog scale (VAS), with measure of morphine consumption. Results: At 3 hours the VSA was: 42 (70%) patients with pain #1 and 18 (30%) #2; at 6 hours the VSA was: 16 (26.6%) patients with pain #2 and 44 (73.3%) #3; at 12 hours the VSA was: 15 (25%) patients with pain #2, 30 (50%) #3, 10 (16.6%) #4 and 5 (8.33%) #5-6. At 23 hours the VAS was: 12 (20%) patients with pain #3, 18 (30%) #4, 20 (33.3%) #5 and 10 (16.6%) #6. At 36 hours and by phone the VSA was: 30 (50%) patients with pain #2-3, 24 (40%) #5 and 6 (10%) #6; at 48 hours and by phone the VAS was: 30 (50%) patients with pain #2-3, 17 (28.3%) #4, 8 (13.3%) #5 and 5 (8.3%) #6. At the 7th day on the first post-op office visit the VAS was: 48 (80%) patients with pain #2-3, 3 (5%) #4-5 and 9 (15%) #5-6. At de 15th day second post-op office visit: 53 (88.3%) patients with pain #2-3 and 7 (11.6%) #4-5. Only one patient 1.66% had urinary retention requiring catheterization in one time. Conclusion: Management of acute perioperatory pain in hemorrhoidectomy with multimodal analgesia is not only feasible but possible and very effective.

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