Management Of Post Haemorrrhoidectomy Pain:

Ahmed Ibrahium Darwish

The operation of haemorrhoidectomy carries a notorious reputation in regard to the severity of post-operative pain,Realization of this fact, has been astimulus to surgans inthe elaboration of alternatives methods for performancethis operation. Thus they found the stretching of theanal sphincters perior to xhe lmv ligation and excisionhaemorrhoideetomy, there is a significant reduction in theamount of pain, than other operations. Also there is minimalpostoperative pain in haemorrhoids treated by cryotherapy.Management of post-haemorrhoidectomy pain prophylacticallybefore operation by inform our patients about thepain, interavenous analgesics during operation, early reliefof flatulence, urinary retantion, nausea will help to raisethe patient threshold of pain.Post-haemorrhoidectomy pain can be reliefed by varioustherapeutic methods, using narcotic analgesics. Morphineis still the drug of choice among powerful analgesics,5 - 10 mg. every 4 - 6 hours in the first day, it rasisthe threshold for pain perception, alter the pattern ofreaction to pain and euphoria and sleep that occurs willraises the threshold for pain. There is a newer narcoticanalgesics with an analgesic eff ect more than morphineas Bupreno:rphine, Pentazocine and Butaphenol.Transperineal pudendal nerve blocks which first performedby Muller in Germany 1900 but has many complicationsuch as pancture of rectum, hematoma and toxic reactions.Caudal analgesia, z-ec ent af.y some centers used caudalyapplied morphine which can give analgesia for about 10hours.On using epidural opiate analgesia to relief posthaemorrhoidectomypain, there is a considerable ameliorationof pain which commenced with 2 - J min., reachedpeak in 10 - 15 min., and was effective for 18 - 48 hours.It is suggested that the morphine reached the subarachnoidspace and produced its effects by direct action on thespecific opiate recoptors in the substantia gelatinosaof the posterior horne cells of the spinal cord.Buprenorphine,is the drug of choice it is excellentanalgesia given in low dose, the duration of action islong but no longer than morphine.Advantage of epidural analgesia is high quality ofanalgesia in low dose, and is free of side-effects attributableto sympathatic and proprioceptive blockade. Disadvantage:itching, nausea and vomiting and urinary retentionand late respiratory depression.from that study the following conclusion can bepostulated:stretching-sphincter perior to excision and low ligationhaemorrhoidectomy can be reduce the post-operative pain.- The analgesic drugs is effective when given to treatalready existing pain, b~t less effective when used prophylacticallybefore the onset of p~in.- Morphine 5 - 10 mg. / 4 - 6 hours in ’the first day isstill the drug of choice. It was rais the threshold forpain perception and alter the patteren of reaction topain.- The newer narcotic drugs are more analgesic effect thanmorphine.- Epidural opiate analgesia, was effective for 18-46 hours.its advantage is high quality of analgesia in low dose.