Department of General Surgery, Albany Medical Center, Albany, New York.
Department of Surgery, University of Vermont Medical Center, Burlington, Vermont.
Dis Colon Rectum. 2018 Jul;61(7):824-829. doi: 10.1097/DCR.0000000000001069.
Postoperative pain is a frequent cause for delayed discharge following outpatient procedures, including anorectal surgery. Both central and peripheral pain receptor sensitization are thought to contribute to postoperative pain. Blocking these receptors and preempting sensitization prevents hyperalgesia leading to lower pain medication requirements. Studies in the orthopedic, urologic, and gynecologic literature support this practice, but the use of preemptive analgesia in anorectal surgery is understudied.
This study aimed to evaluate the effectiveness of preemptive analgesia in decreasing postoperative pain.
This is a randomized, double-blinded, placebo-controlled trial.
This study was conducted at the University of Vermont Medical Center, a tertiary care referral center in Burlington, Vermont.
Patients who were over 18 years of age, ASA Physical Status Classes I, II, or III, and undergoing surgery for anal fissure, fistula or condyloma or hemorrhoids were selected.
Preoperative oral acetaminophen and gabapentin followed by intravenous ketamine and dexamethasone were given before incision compared with oral placebos.
The primary outcomes measured were postoperative pain scores, percentage of patients utilizing breakthrough narcotics, and rates of side effects.
Ninety patients were enrolled. Because of patient withdrawal, screen failures, and loss to follow-up, 61 patients were analyzed (30 in the preemptive analgesia group and 31 in the control group). Patients in the active group had significantly less pain in the postanesthesia care unit and at 8 hours postoperatively. Significantly fewer participants in the active group used narcotics in the postanesthesia care unit and at 8 hours postoperatively. Average pain scores were excellent for both groups. There was no difference in the number of medication-related side effects between the 2 groups.
This study was limited by the small sample size and excellent pain control in both groups.
Preemptive analgesia is safe and results in decreased pain in the early postoperative period following anorectal surgery. It should be implemented by surgeons performing these procedures. See Video Abstract at http://links.lww.com/DCR/A588.
术后疼痛是门诊手术（包括肛肠手术）后延迟出院的常见原因。中枢和外周疼痛受体敏化都被认为是术后疼痛的原因。阻断这些受体并预先防止敏化可防止痛觉过敏，从而减少对止痛药的需求。骨科、泌尿科和妇科文献中的研究支持这种做法，但肛肠手术中预防性镇痛的应用研究不足。
本研究旨在评估预防性镇痛在减轻术后疼痛方面的有效性。
这是一项随机、双盲、安慰剂对照试验。
这项研究在佛蒙特大学医学中心进行，该中心是佛蒙特州伯灵顿的一家三级保健转诊中心。
选择年龄在 18 岁以上、ASA 身体状况 I、II 或 III 级、接受肛裂、瘘管或湿疣或痔疮手术的患者。
与口服安慰剂相比，术前给予口服对乙酰氨基酚和加巴喷丁，然后静脉给予氯胺酮和地塞米松。
主要观察指标为术后疼痛评分、使用突破性麻醉药物的患者比例以及副作用发生率。
共纳入 90 例患者。由于患者退出、筛查失败和随访丢失，最终有 61 例患者进行了分析（预防性镇痛组 30 例，对照组 31 例）。活跃组患者在麻醉后护理单元和术后 8 小时的疼痛明显较轻。活跃组患者在麻醉后护理单元和术后 8 小时使用麻醉药物的人数明显较少。两组患者的平均疼痛评分均极佳。两组药物相关副作用的数量无差异。
本研究受到样本量小和两组患者疼痛控制良好的限制。
预防性镇痛是安全的，可减少肛肠手术后早期的术后疼痛。进行这些手术的外科医生应实施这种镇痛方法。详见视频摘要，网址：http://links.lww.com/DCR/A588。
