Davies Justin, Duffy David, Boyt Nicholas, Aghahoseini Assad, Alexander David, Leveson Stephen
Department of Colorectal Surgery, York District Hospital, York, United Kingdom.
Dis Colon Rectum. 2003 Aug;46(8):1097-102. doi: 10.1007/s10350-004-7286-6.
Pain after hemorrhoidectomy appears to be multifactorial and dependent on individual pain tolerance, mode of anesthesia, postoperative analgesia, and surgical technique. Spasm of the internal sphincter is believed to play an important role. The aim of this study was to assess the role of botulinum toxin in reducing pain after Milligan-Morgan hemorrhoidectomy.
This was a double-blind study of 50 consecutive patients undergoing Milligan-Morgan hemorrhoidectomy and assigned to an internal sphincter injection of 0.4 ml of solution containing either botulinum toxin (20 U; Botox) or normal saline. Patients were managed according to standardized perioperative analgesic and laxative regimens. Pain was assessed by use of daily visual analog scores and analgesia requirements for the first seven postoperative days.
Patients randomized to receive botulinum toxin had lower daily average and maximal visual analog scores throughout the study period. The difference reached significance on both Day 6 (P < 0.05) and Day 7 (P < 0.05). There was no significant difference (P = 0.12) in morphine requirements in the first 24 hours (botulinum group, 16 (range, 6-27) mg; placebo arm, 22 (range, 13-41) mg). Patients who received Botox used 19 (range, 8-36) coproxamol tablets in the first seven days after surgery compared with 23 (range, 10-40) in the placebo arm (P = 0.63).
Those patients who had botulinum toxin had significantly less pain toward the end of the first week after surgery. Reduction in spasm within the internal sphincter is the presumed mechanism of action. This is the first reported randomized, controlled trial using botulinum toxin in hemorrhoidectomy.
痔切除术后疼痛似乎是多因素的，且取决于个体疼痛耐受性、麻醉方式、术后镇痛及手术技术。内括约肌痉挛被认为起重要作用。本研究旨在评估肉毒杆菌毒素在减轻Milligan - Morgan痔切除术后疼痛中的作用。
这是一项双盲研究，对50例连续接受Milligan - Morgan痔切除术的患者进行，将其分为两组，分别向内括约肌注射0.4 ml含肉毒杆菌毒素（20 U；保妥适）或生理盐水的溶液。患者按照标准化的围手术期镇痛和泻药方案进行处理。通过每日视觉模拟评分及术后前七天的镇痛需求来评估疼痛。
在整个研究期间，随机接受肉毒杆菌毒素治疗的患者每日平均和最大视觉模拟评分较低。在第6天（P < 0.05）和第7天（P < 0.05）差异均具有统计学意义。术后24小时内吗啡需求量无显著差异（P = 0.12）（肉毒杆菌毒素组，16（范围6 - 27）mg；安慰剂组，22（范围13 - 41）mg）。接受保妥适治疗的患者在术后前七天使用19（范围8 - 36）片可普洛酚，而安慰剂组为23（范围10 - 40）片（P = 0.63）。
接受肉毒杆菌毒素治疗的患者在术后第一周结束时疼痛明显减轻。内括约肌痉挛减轻被认为是其作用机制。这是首次报道在痔切除术中使用肉毒杆菌毒素的随机对照试验。
