Effects of Reduction of Early Postoperative Anal Pain following Hemorrhoid Surgery with Epidural Anesthesia: A Pilot...

Hemorrhoids commonly occur worldwide, and surgical intervention is required in severe cases. However, a method for postoperative pain control is yet to be established. In this study, we developed a caudal epidural anesthesia tube placement method and demonstrated its meaningful outcomes.

We postoperatively analyzed 85 patients who underwent hemorrhoid surgery at the Sapporo Ishiyama Hospital. Using a computer-generated method, patients were assigned to the caudal epidural tube placement group (E group; n = 47) or without tube placement group (N group; n = 38) and compared using a numeric rating scale (NRS).

Goligher classification grade ≥3 severe hemorrhoids were found in 93% of patients in the study. Anal cushion lifting (ACL), a surgical technique requiring no hemorrhoid resection with or without excision (e.g., Milligan-Morgan hemorrhoidectomy), was used. Swelling was observed in 15% of overall patients, but it was controlled with conservative treatment. Postoperative bleeding occurred in one patient in the N group. The mean duration of caudal epidural tube placement was 33.7 h, and there were no adverse events such as infection. The NRS results showed that the E group had a significantly lower mean NRS score at postoperative 24 and 48 h compared with the N group. No apparent rebound pain after tube removal occurred, and the transition to an oral analgesic was smooth and successful.

Our novel method may contribute to the pain management during early periods following hemorrhoidectomy.