Feng Jingjuan, Cheng Jian, Xiang Feng
Department of Anorectal Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
Department of Anorectal Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China. Email:
Ann Palliat Med. 2021 Jan;10(1):479-483. doi: 10.21037/apm-20-2385.
Post-hemorrhoidectomy pain is common, usually temporary, and responsive to analgesics. However, some patients experience prolonged, intractable anal pain, which is refractory to conventional analgesics and adversely effects quality of life. We aimed to evaluate the efficacy of a combination injection containing local anesthesia and steroids for the treatment of intractable post-hemorrhoidectomy anal pain.
This study included five patients with intractable post-hemorrhoidectomy anal pain who presented between July 2015 and November 2018. Milligan-Morgan hemorrhoidectomy (M-M) with a sclerosant injection had been performed in three patients and stapled hemorrhoidectomy (SH) along with external hemorrhoidectomy in two. For the purpose of this study, all patients received local combination injections containing ropivacaine and triamcinolone acetonide. The primary outcome was the visual analogue scale (VAS) score, and secondary outcomes included the Pittsburgh Sleep Quality Index (PSQI) score, adverse reactions, and recurrence.
Prior to treatment, the VAS score was 8 in one patient and 5-7 in four, and the PSQI score was ≥16 in all patients. The injection was administered once (n=4) or twice (n=1). Rapid pain resolution was achieved on the day of treatment (VAS scores 0-3), and patients reported undisturbed sleep the same night. VAS scores were 0-2 (n=4) and 1-3 (n=1), and the PQSI scores were 0-6 (n=4) and 11-15 (n=1) at the 6-month follow-up. No patient reported significant pain or adverse reaction.
Intractable post-hemorrhoidectomy anal pain is rare but significantly effects quality of life. While conventional analgesia may be ineffective, the local injection of anti-inflammatory and analgesic drugs may be a useful treatment strategy.
痔切除术后疼痛很常见，通常是暂时的，且对镇痛药有反应。然而，一些患者会经历持续时间长、难以治疗的肛门疼痛，这种疼痛对传统镇痛药无效，并对生活质量产生不利影响。我们旨在评估一种含有局部麻醉药和类固醇的联合注射剂治疗痔切除术后顽固性肛门疼痛的疗效。
本研究纳入了2015年7月至2018年11月期间出现痔切除术后顽固性肛门疼痛的5例患者。3例患者接受了带有硬化剂注射的Milligan-Morgan痔切除术（M-M），2例患者接受了吻合器痔上黏膜环切术（SH）及外痔切除术。为了本研究的目的，所有患者均接受了含有罗哌卡因和曲安奈德的局部联合注射。主要结局指标是视觉模拟评分（VAS），次要结局指标包括匹兹堡睡眠质量指数（PSQI）评分、不良反应和复发情况。
治疗前，1例患者的VAS评分为8分，4例患者的评分为5-7分，所有患者的PSQI评分均≥16分。注射1次（n=4）或2次（n=1）。治疗当天疼痛迅速缓解（VAS评分0-3分），患者报告当晚睡眠未受干扰。6个月随访时，VAS评分0-2分（n=4）和1-3分（n=1），PSQI评分0-6分（n=4）和11-15分（n=1）。没有患者报告明显疼痛或不良反应。
痔切除术后顽固性肛门疼痛很少见，但对生活质量有显著影响。虽然传统镇痛可能无效，但局部注射抗炎和镇痛药可能是一种有效的治疗策略。
