대한대장항문학회

Purpose : An adequate pain control is one of important factors for obtaining good outcomes<br>in the ambulatory basis of hemorrhoidectomy. There have been many methods for pain<br>control after hemorrhoidectomy such as narcotics, various kinds of analgesics, etc. The aim<br>of this study is to compare intraoperative internal anal sphincter injection of Ketorolac<br>tromethamine and other two conventional methods for pain control. Methods : A total of 56<br>patients with hemorrhoid grade III or IV underwent surgery between May and October 1999,<br>and prospectively assigned to three groups in the consecutive order. The group was divided<br>in Group 1: [Ketorolac tromethamine (Tarasyn) 60 mg intrasphincteric injection<br>intraoperatively and 30 mg IM/prn 10 mg po/6hrs], Group 2: [No intraoperative injection and<br>maintain pain control with Tarasyn 30 mg IM/prn 10 mg po/6hrs], and Group 3: [No<br>intraoperative injection and maintain pain control with Pethidine (Demerol) 50 mg IM/prn and<br>Ibuprofen 400 mg Paracetamol 500 mg Codeine 20 mg (Myprodol) po/8hrs]. The post<br>operative data and pain scoring was performed on the questionnaire with Point box scale<br>(BS-11) and Behavioral rating scale (BRS-6) each 24 hours during 5 days after surgery.<br>Results : There are 22 patients in the Group 1, 16 in the Group 2 and 18 patients in the Group<br>3. The median age of the Group 1 is 42.5, Group 2, 44.5 and Group 3, 45 years. The pain<br>score on the first day after surgery in group 1 was significantly lower than group 2 (p＜0.05)<br>in the both pain scoring scale but was no differences between group 1 and 3. On the fifth day<br>after surgery group 3 was significantly lower than both group 1 and 2 in the point box scale<br>(p＜0.05). The urinary retention rate and the day of first bowel movement after surgery show<br>no differences among three groups (p＞0.05). Conclusions : Intraoperative internal anal<br>sphincter injection of Ketorolac tromethamine shows a better pain control than conventional<br>methods in early postoperative period. Therefore it might be helpful for patients to go home<br>on the day after surgery, and strong pain killer to control pain after discharge will be needed.<br>