The pain of haemorrhoidectomy: a prospective study

The efficacy of a multimodal analgesic approach for ligation excision haemorrhoidectomy was evaluated in a prospective series of 62 patients. Opioid was given as intravenous fentanyl intra-operatively, as part of a standardised general anaesthetic technique, followed by post-operative parenteral fentanyl or oral oxycodone as required. Pre-emptive local anaesthesia was provided via ischiorectal fossae and haemorrhoid pedicle infiltration. The non-steroidal anti-inflammatory drug indomethacin was administered rectally at the end of surgery and regularly orally for 5 post-operative days. A wide range of pain scores was recorded post-operatively but all mean scores were between 2 and 3. Pain was highest at the time of the first bowel action but this was successfully managed in the patient's home. Patient satisfaction with their pain management was achieved in 95% of patients. We conclude that the multimodal analgesia technique combined with pre-operative patient education leads to successful pain control following haemorrhoidectomy.