Department of Anesthesiology, Zhejiang Hospital, Hangzhou, China.
Department of Anorectal Medicine, Zhejiang Hospital, Hangzhou, China.
Pain Res Manag. 2022 Feb 4;2022:2033580. doi: 10.1155/2022/2033580. eCollection 2022.
Postoperative pain is a major adverse effect of surgery for mixed hemorrhoids. We evaluated whether spinal anesthesia with ropivacaine and hydromorphone provided safe and effective analgesia after surgery for mixed hemorrhoids.
This single-center, double-blind pilot study included patients with mixed hemorrhoids who underwent a procedure for prolapse and hemorrhoids (PPH) and external hemorrhoidectomy under spinal anesthesia at Zhejiang Hospital, China (October 2020 to December 2020). Patients were randomized to a hydromorphone group (spinal anesthesia with 0.5% ropivacaine and 75 g hydromorphone) or morphine group (spinal anesthesia with 0.5% ropivacaine and 150 g morphine). Pain scores (numerical rating scale), incidences of vomiting and itching, and length of hospital stay (LoS) were recorded at 6, 12, 18, and 24 hours after surgery.
The analysis included 40 patients in each group. Median (interquartile range) pain score in the hydromorphone group was higher than that in the morphine group at 12 hours (1 (0-2] vs. 0 (0-2), =0.044) but not significantly different between groups at 6 hours (0 (0-1) vs. 0 (0-0) =0.228), 18 hours (2 (2-3) vs. 2 (1-3) =0.060) or 24 hours (2 (2-3) vs. 2 (1-3) =0.081). The hydromorphone group had a lower incidence of pruritus than the morphine group (47.5% vs. 67.5%, =0.018). There were no significant differences between groups in vomiting incidence or LoS.
In patients with mixed hemorrhoids, spinal anesthesia with ropivacaine/hydromorphone has a comparable analgesic effect and a lower incidence of pruritus during the first 24 hours after surgery than spinal anesthesia with ropivacaine/morphine.
术后疼痛是混合痔手术的主要不良反应。我们评估了罗哌卡因和氢吗啡酮的椎管内麻醉在痔环切术和外痔切除术（PPH）中的应用是否能提供安全有效的术后镇痛。
这是一项在中国浙江医院进行的单中心、双盲试点研究，纳入了在椎管内麻醉下接受 PPH 和外痔切除术的混合痔患者（2020 年 10 月至 2020 年 12 月）。患者被随机分为氢吗啡酮组（椎管内麻醉用 0.5%罗哌卡因和 75μg氢吗啡酮）或吗啡组（椎管内麻醉用 0.5%罗哌卡因和 150μg吗啡）。记录术后 6、12、18 和 24 小时的疼痛评分（数字评分量表）、呕吐和瘙痒发生率以及住院时间（LoS）。
每组分析纳入 40 例患者。氢吗啡酮组的中位（四分位间距）疼痛评分在 12 小时时高于吗啡组（1（0-2]分比 0（0-2]分，=0.044），但在 6 小时时两组间无显著差异（0（0-1]分比 0（0-0]分，=0.228），18 小时时（2（2-3]分比 2（1-3]分，=0.060）或 24 小时时（2（2-3]分比 2（1-3]分，=0.081）。氢吗啡酮组瘙痒发生率低于吗啡组（47.5%比 67.5%，=0.018）。两组呕吐发生率和 LoS 无显著差异。
在混合痔患者中，罗哌卡因/氢吗啡酮的椎管内麻醉在术后 24 小时内的镇痛效果与罗哌卡因/吗啡相似，瘙痒发生率较低。
