Huang Johnny, Rickard Matthew J F X, Keshava Anil, Suen Michael K L
Discipline of Surgery, School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Division of Colorectal Surgery, Department of Surgery, Concord Repatriation General Hospital, The University of Sydney, Concord Clinical School, Sydney, New South Wales, Australia.
ANZ J Surg. 2020 Apr;90(4):580-584. doi: 10.1111/ans.15732. Epub 2020 Feb 16.
Haemorrhoidectomy is associated with significant post-operative pain which is primarily managed pharmacologically. Whether a non-pharmacological adjunct such as a checklist can improve pain outcomes after an open haemorrhoidectomy has yet to be studied. The purpose of this study was to determine if a patient-completed checklist of prescribed post-haemorrhoidectomy pain medications would improve pain management after surgery.
We conducted a dual-centre randomized controlled trial of patients undergoing a Milligan-Morgan haemorrhoidectomy for symptomatic third or fourth degree haemorrhoids. Thirty-five patients were randomized into either a control group which received post-operative pain medication plus a visual analogue scale (VAS) form, or an intervention group which received a post-operative medication checklist in addition to the items the control group received. Both groups recorded their pain levels on the VAS forms at 10.00, 14.00 and 20.00 hours each day for 14 days post-operatively.
Patients in the checklist group reported a significantly greater reduction in mean VAS pain score of 2.51 (95% confidence interval (CI) 1.34-3.68; P < 0.001) between day 1 post-op and day 14 post-op compared to 1.86 (95% CI 0.77-2.95; P = 0.001) for the control group. There was no significant difference between mean pain experienced by patients in either group over each of the 14 days individually or overall (P = 0.07).
The pain medication checklist lead to a greater reduction in pain between day 1 and 14 after an open haemorrhoidectomy compared to standard care but did not significantly reduce mean pain across any individual days or overall.
痔切除术会导致严重的术后疼痛，主要通过药物治疗。诸如检查表之类的非药物辅助手段能否改善开放式痔切除术后的疼痛结局，尚无研究。本研究的目的是确定患者完成的痔切除术后规定止痛药物检查表是否能改善术后疼痛管理。
我们对因有症状的三度或四度痔疮接受Milligan-Morgan痔切除术的患者进行了一项双中心随机对照试验。35名患者被随机分为对照组，接受术后止痛药物加视觉模拟量表（VAS）表格，或干预组，除接受对照组的项目外，还接受术后药物检查表。两组患者在术后14天内每天10:00、14:00和20:00在VAS表格上记录疼痛程度。
检查表组患者术后第1天至第14天的平均VAS疼痛评分显著降低2.51（95%置信区间（CI）1.34 - 3.68；P < 0.001），而对照组为1.86（95%CI 0.77 - 2.95；P = 0.001）。两组患者在14天中任何一天或总体上经历的平均疼痛无显著差异（P = 0.07）。
与标准护理相比，痔切除术后疼痛药物检查表在术后第1天至第14天能更大程度地减轻疼痛，但在任何一天或总体上均未显著降低平均疼痛程度。
