Zhao Y, Ding J-H, Yin S-H, Hou X-L, Zhao K
Department of Colorectal Surgery, Second Artillery General Hospital, Beijing, China.
Colorectal Dis. 2014 Jun;16(6):O206-11. doi: 10.1111/codi.12531.
Moderate to severe pain after stapled haemorrhoidopexy (SH) is not uncommon. This study was designed to identify the predictors of postoperative pain after SH in a single centre.
Seventy-six patients with Grade II to IV haemorrhoids who underwent SH were selected from a prospectively compiled database. Preoperative data, including patient characteristics, manometry results and surgical data, were documented. Pain was evaluated during the first 24 h after the operation. Its intensity was classified into three grades according to the visual analogue scale (VAS) score: mild (VAS ≤ 3), moderate (VAS >3 to <5) and severe (VAS ≥ 5). Analgesics were not routinely given but were administered if the patient had moderate or severe pain. Both univariate and multivariate analyses were used to determine the predictors of postoperative pain.
Moderate and severe pain was noted in 43 (58.9%) patients. No patient was readmitted due to persistent anal pain during the month following discharge. Postoperative pain was significantly associated with gender (P = 0.017), age (P = 0.014), first initial sensory volume (P = 0.023) and constipation (P = 0.005) in univariate analysis. Multivariate analysis identified male gender as an independent predictor of postoperative moderate to severe pain (P = 0.037, OR = 3.1, 95% CI 1.07-9.09). The initial sensory volume and preoperative coexisting constipation were negative predictors of postoperative moderate to severe pain after SH (P = 0.037, OR = 0.320, 95% CI 0.110-0.934, and P = 0.036, OR = 0.255, 95% CI 0.071-0.913, respectively).
Male gender and the initial sensory volume are predictors of postoperative pain after SH. Anal manometry is recommended before the SH procedure. An active analgesia protocol should be considered for male patients with a low initial sensory volume after SH.
吻合器痔上黏膜环切术（SH）后出现中重度疼痛并不罕见。本研究旨在确定单中心SH术后疼痛的预测因素。
从一个前瞻性汇编的数据库中选取76例接受SH的Ⅱ至Ⅳ度痔疮患者。记录术前数据，包括患者特征、测压结果和手术数据。在术后24小时内评估疼痛情况。根据视觉模拟量表（VAS）评分将疼痛强度分为三个等级：轻度（VAS≤3）、中度（VAS>3至<5）和重度（VAS≥5）。不常规给予镇痛药，但若患者有中度或重度疼痛则给予。采用单因素和多因素分析来确定术后疼痛的预测因素。
43例（58.9%）患者出现中度和重度疼痛。出院后1个月内无患者因持续性肛门疼痛再次入院。单因素分析显示，术后疼痛与性别（P = 0.017）、年龄（P = 0.014）、初始感觉容量（P = 0.023）和便秘（P = 0.005）显著相关。多因素分析确定男性为术后中重度疼痛的独立预测因素（P = 0.037，OR = 3.1，95%CI 1.07 - 9.09）。初始感觉容量和术前并存便秘是SH术后中重度疼痛的负性预测因素（分别为P = 当P = 0.037，OR = 0.320，95%CI 0.110 - 0.934，以及P = 0.036，OR = 0.255，95%CI 0.071 - 0.913）结论：男性和初始感觉容量是SH术后疼痛的预测因素。建议在SH手术前进行肛门测压。对于SH术后初始感觉容量低的男性患者，应考虑采用积极的镇痛方案。
