The Effect of Early Warm Plastic Bag Application on Postoperative Pain after Hemorrhoidectomy: A Prospective Randomized Controlled Trial

摘要

Hemorrhoidectomy is used for the surgical treatment of high-grade hemorrhoids. The most prominent complaint after hemorrhoidectomy is pain. Postoperative pain management is still a big problem after surgery in patients with hemorrhoidectomy. The aim of the study was to assess the effect of early application of warm bag on postoperative pain after hemorrhoidectomy. All patients were randomly divided into warm plastic bag and control groups by using sealed envelopes, which were prepared preoperatively. After standard spinal anesthesia, all patients underwent standard Milligan-Morgan hemorrhoidectomy using Ligasure?. Although the study group received the warm bag application, the control group did not receive such a treatment. Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement. Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation. Additionally, a significant difference existed between the two groups in terms of the need for additional anesthesia. Local thermal application appears to be a safe and effective method for pain relief after hemorrhoidectomy. Hemorrhoidectomy IS used for the surgical treatment of high-grade hemorrhoids or hemorrhoids that do not respond to nonsurgical management. The most prominent complaint after hemorrhoidal surgery is pain, which is thought to arise from surgical trauma and the associated inflammatory reaction resulting from the spasm of the internal anal sphincter (IAS). Additionally, the intensive sensory neural network within the perianal and anodermal regions may contribute to pain perception. In addition to analgesics used for postoperative pain control after hemorrhoidectomy, warm water baths are commonly used for pain management as a safe method with relatively lower morbidity.5 Similarly, the same method is applied after certain gynecological and uro-logical procedures both for pain control and to accelerate healing. It has been reported that warm water baths are associated with a relaxation in the IAS resulting in pain reduction and the continued relaxation of the sphincter correlates with the temperature of the water. The relaxation of IAS after the exposure of the perianal skin to warm water has been referred to as the ‘‘thermosphincteric reflex."