Sirikurnpiboon Siripong, Jivapaisarnpong Paiboon
Division of Colorectal Surgery, Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
J Anus Rectum Colon. 2020 Oct 29;4(4):186-192. doi: 10.23922/jarc.2020-027. eCollection 2020.
Hemorrhoid is a common disease in surgical practice, but only a few numbers of patients need surgical treatment. The most common concern of patients is postoperative pain. This study aimed to evaluate the efficacy and safety of an intersphincteric injection of botulinum toxin for post-hemorrhoidectomy pain relief.
Overall, 90 patients were enrolled, and 44 were randomized into a botulinum toxin injection group. Preoperative gradings were grade III 37 patients and grade II 2 patients. Patients received an intersphincteric injection of 0.5 ml of a solution containing 30 units of botulinum toxin (BTX). The postoperative data were collected pain score in a visual analog score (VAS), an analgesic used, hospital stay, and complication.
The VAS was lower in the BTX group at 12 hours and 24 hours postoperative phase. VAS at 12 hours 4.435 ± 2.149 vs 6.232 ± 2.307 (p < 0.001), VAS at 24 hours 2.205 ± 2.079 vs 3.744 ± 2.361(p = 0.003). The BTX group has a shorter time in defection without pain than the control group (3 vs. two days, p = 0.007). There was no difference in immediate and delay complications between the two groups.
Postoperative hemorrhoidectomy needs multimodalities for pain reduction. Botulinum toxin has some benefit in postoperative pain reduction.
痔疮是外科手术中常见的疾病，但只有少数患者需要手术治疗。患者最常见的担忧是术后疼痛。本研究旨在评估括约肌间注射肉毒杆菌毒素缓解痔切除术后疼痛的有效性和安全性。
总共纳入90例患者，44例被随机分为肉毒杆菌毒素注射组。术前分级为Ⅲ级37例患者和Ⅱ级2例患者。患者接受括约肌间注射0.5毫升含30单位肉毒杆菌毒素（BTX）的溶液。收集术后数据，包括视觉模拟评分（VAS）的疼痛评分、使用的镇痛药、住院时间和并发症。
BTX组术后12小时和24小时的VAS较低。术后12小时VAS为4.435±2.149 对比6.232±2.307（p<0.001），术后24小时VAS为2.205±2.079对比3.744±2.361（p = 0.003）。BTX组无痛排便时间比对照组短（3天对比2天，p = 0.007）。两组之间即刻和延迟并发症无差异。
痔切除术后需要多种方式减轻疼痛。肉毒杆菌毒素在减轻术后疼痛方面有一定益处。
