| Objective:To find out a method for pain relieving during and after anal surgery, on which basis to develop a safe, simple and clinically promotable pain control protocol that reduces the value of pain, the occurrence of complications and side effects. The purposes are to relieve the feeling of pain during and after the surgery, to reduce the occurrence of complications or to keep the symptoms as mild as possible when complications do develop so as to ultimately improve the quality of life for the patients during recovery.Methods:The study was a randomized controlled trial (RCT). Inclusion criteria:patients diagnosed as mixed hemorrhoid according to western medicine, diagnosed as hemorrhoids according to traditional Chinese medicine with the pattern of damp-heat flowing downward, had Milligan-Morgan operation for mixed hemorrhoid with2-4incisions. The patients were assigned with random numbers in the order of inclusion time and were grouped accordingly. The experiment group were given preoperative intravenous propofol for general anesthesia as well as local infiltration anesthesia and postoperative long-acting analgesic (methylene blue compound) for local injection. While the control group used lidocaine by local infiltration combined with midazolam for stronger anesthetic effect before surgery, and routine postoperative analgesic (indomethacin) after. Scores for pain, urinary retention, sleep and postoperative edema were recorded on the day of surgery and also on the1st,2nd,3rd and4th day after the surgery. SPSS17.0was applied in statistical assessment. The index for the efficacy of long-acting analgesics, safety index and baseline data were analyzed and evaluated. P<0.05by chi-square test was considered statistically significant.Results:Patients with the same course length of treatment in different group showed no significant difference in pain during surgery. However, postoperative analgesia scores were significantly different between the experiment group (methylene blue compound) and the control group (indometacin suppositories), P=0.007(P<0.05). Difference in the1st day was statistically significant (P=0.014, P<0.05) but that of the2nd,3rd and4th day had no statistical significance (P>0.05). The analgesia effect in the experiment group was better than the control group on the day of surgery and the Is1day after. Urinary retention scores were statistically significant on the1st day after operation (P=0.017, P<0.05) but were not significant on the days afterwards. Sleep scores were significantly different on the2nd and3rd day (P=0.043,P=0.020; P<0.05) but not on the other days. Scores for wound-edge edema showed no significant difference (P>0.05for all4days after operation).Conclusion:Both groups showed pain-relieving effect. Preoperative intravenous propofol for general anesthesia and local infiltration anesthesia plus postoperative long-acting analgesic for local injection effectively reduced pain value during surgery and the1st day after. The two groups showed no significant difference afterwards. Both postoperative analgesia protocols were effective, but methylene blue compound took effect immediately after injection while indometacin suppositories were much slower. As a result, methylene blue compound injection performed better than indometacin suppositories for postoperative pain control. Both protocols reduced postoperative urinary retention, but methylene blue compound had stronger effect on the1st day after surgery. Intergroup pain scores were significantly different on the2nd and3rd day, but no significant difference was observed on the day of surgery and the lsl day after. It concludes that the2protocols have similar effect on patient’s sleep. There was no clear relevance between the occurrence of wound-edge edema and the choice of either anesthesia protocol or the analgesia protocol. Propofol by both intravenous injection and local infiltration plus postoperative local injection of long-acting analgesics have immediate pain killing effect as early as the day of surgery. While infiltration anesthesia plus indometacin suppositories take longer to show effect and thus needs long-term application. Both protocols barely cause complications and neither tends to induce side effects or drug dependence. The author therefore concludes that the experiment protocol, which is convenient to operate, quicker to take effect and safe, is a reliable method to improve patients’quality of life throughout the recovery period after anal surgery, and thus is worthy of promotion in clinical practice. |
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