Preemptive Analgesia for Hemorrhoidectomy: Study Protocol for a Prospective, Randomized, Double-Blind Trial

Abstract

\n Background: Hemorrhoidectomy is associated with intense postoperative pain that requires the multimodal analgesia. It includes Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), acetaminophen and local anesthetics to reach the adequate pain control. There are data in literature preemptive analgesia could decrease postoperative pain after hemorrhoidectomy. The aim of this study is to assess the efficiency of preemptive analgesia with Ketoprofen 10 mg 2 hours before procedure per os with spinal anesthesia to decrease postoperative pain and the amount of used analgesics. Methods: Patients of our clinic who meet the following inclusion criteria are included: haemorrhoids grade III-IV and the planned Milligan-Morgan hemorrhoidectomy. After signing the consent all participants are randomly divided into 2 groups: the first one gets a tablet with 10 mg Ketoprofen, the second one gets a tablet containing starch per os 2 hours before surgery (72 participants per arm). Patients of both arms receive spinal anesthesia and undergo open hemorrhoidectomy. Following the procedure the primary and secondary outcomes are evaluated: opioid administration intake, the pain at rest and during defecation, duration and frequency of other analgesics intake, readmission rate, overall quality of life, time from the procedure to returning to work and the complications rate. Discussion: Multimodality pain management has been shown to improve pain control and decrease opioid intake in patients after hemorrhoidectomy in several studies. Gabapentin can be considered as an alternative approach to pain control as NSAIDs have limitative adverse effects. Systemic admission of ketorolac with local anesthetics also showed significant efficacy in patients undergoing anorectal surgery. We hope to prove the efficacy of multimodal analgesia including preemptive one for patients undergoing excisional hemorrhoidectomy that will help to hold postoperative pain level no more than 3-4 points on VAS with minimal consumption of opioid analgesics. Registered at clinicaltrial.gov number ID NCT04361695 , date of registration: April 24, 2020, version 1.0