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Open Access 01-12-2022 | Milligan-Morgan Hemorrhoidectomy | Study protocol

Preemptive analgesia for hemorrhoidectomy: study protocol for a prospective, randomized, double-blind trial

Authors: Ekaterina Kazachenko, Tatiana Garmanova, Alexander Derinov, Daniil Markaryan, Hanjoo Lee, Sabrina Magbulova, Petr Tsarkov

Published in: Trials | Issue 1/2022

Abstract

Background

Hemorrhoidectomy is associated with intense postoperative pain that requires multimodal analgesia. It includes nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and local anesthetics to reach adequate pain control. There are data in literature preemptive analgesia could decrease postoperative pain after hemorrhoidectomy. The aim of this study is to assess the efficacy of preemptive analgesia with ketoprofen 100 mg 2 h before procedure per os with spinal anesthesia to decrease postoperative pain according to visual analog scale and to reduce the opioids and other analgesics consumption.

Methods

Patients of our clinic who meet the following inclusion criteria are included: hemorrhoids grade III–IV and the planned Milligan-Morgan hemorrhoidectomy. After signing the consent all participants are randomly divided into 2 groups: the first one gets a tablet with 100 mg ketoprofen, the second one gets a tablet containing starch per os 2 h before surgery (72 participants per arm). Patients of both arms receive spinal anesthesia and undergo open hemorrhoidectomy. Following the procedure the primary and secondary outcomes are evaluated: opioid administration intake, the pain at rest and during defecation, duration, and frequency of other analgesics intake, readmission rate, overall quality of life, time from the procedure to returning to work, and the complications rate.

Discussion

Multimodality pain management has been shown to improve pain control and decrease opioid intake in patients after hemorrhoidectomy in several studies. Gabapentin can be considered as an alternative approach to pain control as NSAIDs have limitative adverse effects. Systemic admission of ketorolac with local anesthetics also showed significant efficacy in patients undergoing anorectal surgery. We hope to prove the efficacy of multimodal analgesia including preemptive one for patients undergoing excisional hemorrhoidectomy that will help to hold postoperative pain levels no more than 3–4 points on VAS with minimal consumption of opioid analgesics.

Trial registration

ClinicalTrial.govNCT04361695. Registered on April 24, 2020, version 1.0.

Available only for authorised users

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Title: Preemptive analgesia for hemorrhoidectomy: study protocol for a prospective, randomized, double-blind trial
Authors: Ekaterina Kazachenko
Tatiana Garmanova
Alexander Derinov
Daniil Markaryan
Hanjoo Lee
Sabrina Magbulova
Petr Tsarkov
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Milligan-Morgan Hemorrhoidectomy
Hemorrhoidectomy
Spinal Anesthesia
Opioids
Opioids
Hemorrhoids
Ketoprofen
Analgesics in Dentistry
Hemorrhoidectomy
Anesthetics
Anesthetics
Published in: Trials / Issue 1/2022
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/s13063-022-06107-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preemptive analgesia for hemorrhoidectomy: study protocol for a prospective, randomized, double-blind trial

Abstract

Background

Methods

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

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