Subcutaneous morphine pump for postoperative hemorrhoidectomy pain management

Area of Science:

• Surgical Procedures
• Pain Management
• Ambulatory Surgery

Background:

• Hemorrhoidectomy traditionally requires inpatient care due to postoperative pain.
• Parenteral narcotics are typically needed for effective pain management post-hemorrhoidectomy.
• Outpatient anorectal procedures are common, but hemorrhoidectomy is an exception.

Purpose of the Study:

• To investigate the efficacy of a subcutaneous morphine pump (SQMP) for outpatient pain control after hemorrhoidectomy.
• To determine if SQMP can facilitate ambulatory hemorrhoidectomy procedures.
• To assess the effectiveness and cost-effectiveness of SQMP in this setting.

Main Methods:

• Phase 1: Compared SQMP protocol (n=22) with conventional narcotic dosing (n=29) for radical hemorrhoidectomy patients.
• Phase 2: Evaluated SQMP protocol in an ambulatory setting for hemorrhoidectomy (n=19).
• Assessed hospitalization length, catheterization rates, pain control, and cost-effectiveness.

Main Results:

• Phase 1: Zero patients on SQMP required extended hospitalization for pain compared to two in the control group. Pain control was satisfactory in 21/22 patients.
• Phase 2: 18/19 patients on SQMP were discharged from the recovery room, enabling outpatient procedures.
• Minor side effects occurred in 18/22 patients, with pump removal in two; cost analysis indicated SQMP is cost-effective for outpatient hemorrhoidectomy.

Conclusions:

• The SQMP facilitates outpatient hemorrhoidectomy by providing effective pain management.
• The SQMP demonstrates high patient acceptance and cost-effectiveness.
• Ambulatory hemorrhoidectomy with SQMP is a viable and beneficial approach.