Long Qing, Li Jun, Li Yan
Department of Traditional Chinese Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Dermatology, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou, China.
Front Surg. 2023 Apr 3;10:1132277. doi: 10.3389/fsurg.2023.1132277. eCollection 2023.
OBJECTIVE: Subcutaneous injection of methylene blue around the anus may help reduce postoperative pain. However, the concentration of methylene blue is still controversial. Therefore, Our study aims to investigate the efficacy and safety of different methylene blue injected concentrations subcutaneously in pain treatment after hemorrhoidectomy. METHODS: A total of 180 consecutive patients with grade III or IV hemorrhoids from March 2020 to December 2021 were reviewed. All patients underwent hemorrhoidectomy under spinal anesthesia and were divided into three groups. Group A received subcutaneous injection of 0.1% methylene blue after hemorrhoidectomy, group B received subcutaneous injection of 0.2% methylene blue, and Group C did not received subcutaneous injection of methylene blue. The primary outcome measures were the visual analog scale (VAS) pain score on postoperative days 1, 2, 3, 7, 14, and total analgesic consumption within 14 days. Secondary outcomes were complications after hemorrhoidectomy, including acute urinary retention, secondary bleeding, perianal incision edema, and perianal skin infection, and the Wexner scores used to assess the level of anal incontinence at one and three months after surgery. RESULTS: There was no significant difference among three groups in sex, age, course of the disease, hemorrhoid grade and the number of incisions, and there was no significant difference in the volume of methylene blue injected between group A and group B. The VAS pain score and total analgesics consumption within 14 days in group A and group B were significantly lower than those in group C, but the differences between group A and group B were not statistically significant. The Wexner scores of group B were significantly higher than those of group A and group C one month after the operation, but the differences between group A and group C were not statistically significant. In addition, the Wexner score among three groups decreased to zero at three months after operation. There was no significant difference in the incidence of other complications among three groups. CONCLUSION: The perianal injection of 0.1% methylene blue and 0.2% methylene blue have a similar analgesic effect in pain treatment after hemorrhoidectomy, but 0.1% methylene blue has higher safety.
目的：在肛门周围皮下注射亚甲蓝可能有助于减轻术后疼痛。然而，亚甲蓝的浓度仍存在争议。因此，我们的研究旨在探讨不同浓度亚甲蓝皮下注射在痔切除术后疼痛治疗中的疗效和安全性。 方法：回顾性分析2020年3月至2021年12月期间连续收治的180例III或IV度痔患者。所有患者均在蛛网膜下腔麻醉下行痔切除术，并分为三组。A组在痔切除术后皮下注射0.1%亚甲蓝，B组皮下注射0.2%亚甲蓝，C组未皮下注射亚甲蓝。主要观察指标为术后第1、2、3、7、14天的视觉模拟评分（VAS）疼痛评分以及14天内的总镇痛药物消耗量。次要观察指标为痔切除术后的并发症，包括急性尿潴留、继发性出血、肛周切口水肿和肛周皮肤感染，以及用于评估术后1个月和3个月肛门失禁程度的Wexner评分。 结果：三组患者在性别、年龄、病程、痔分级和切口数量方面无显著差异，A组和B组注射的亚甲蓝体积也无显著差异。A组和B组术后14天内的VAS疼痛评分和总镇痛药物消耗量均显著低于C组，但A组和B组之间的差异无统计学意义。术后1个月，B组的Wexner评分显著高于A组和C组，但A组和C组之间的差异无统计学意义。此外，三组术后3个月时Wexner评分均降至零。三组其他并发症的发生率无显著差异。 结论：肛周注射0.1%和0.2%亚甲蓝在痔切除术后疼痛治疗中的镇痛效果相似，但0.1%亚甲蓝安全性更高。
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