The Effect of Anal Packing on Urinary Retention after Hemorrhoidectomy under the Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Urinary retention after anorectal surgery is thought to be a mild complication but has a high incidence. Since anal pain and distention can contribute to the urethral spasm reflex which may cause urinary retention, we investigated the effect of absorbable gelatin sponge (Gelfoam(R)) used for anal packing postoperatively on urinary retention after hemorrhoidectomy under spinal anesthesia. METHODS: One hundred and nineteen ASA Physical Status I patients scheduled for hemorrhoidectomy were selected. Patients were randomly divided into Group A, postoperative anal packing free group and Group B, postoperative anal packing group and studied prospectively. Spinal anesthesia was performed with the bevel of 25 gauge Quincke needle parallel to dura fibers at lumber 3 4 intervertebral space and the injection of hyperbaric 0.5% tetracaine 6 mg (1.2 ml) to patients in sitting position. After hemorrhoidectomy, all patients were permitted to ambulate as soon as possible and urinate spontaneously. If urinary retention occurred, urinary catheterization was done temporarily. The number of patients who received urinary catheterization were recorded. Surgical technique and the total amount of intravenous fluid during the operation were controlled. RESULTS: The incidence of urinary retention in Group A (11/57, 19.3%) was similar to that in Group B (10/62, 16.1%) (P = 0.651, chi 2 = 0.205, degree of freedom = 1). CONCLUSIONS: Our study did not indicate the clue that the absence of anal packing helped to reduce the incidence of urinary retention after hemorrhoidectomy under spinal anesthesia.

The Analgesic Effect of Ketorolac Administered in a Hemorrhoidectomy / 대한마취과학회지

BACKGROUND: Moderate to severe postoperative pain is still treated with an intermittent intramuscular injection of narcotics. Recently introduced ketorolac is a nonsteroidal anti-inflammatory drug that has analgesic property comparable to morphine and does not increase opioid-associated side effects such as respiratory depression, nausea and vomiting. We evaluate the analgesic effect of ketorolac directly injected around the anal sphincter muscle during a hemorrhoidectomy. METHODS: Forty adult patients undergoing hemorrhoidectomy were randomly assigned to one of two groups. Both groups received the operation under saddle block and by one surgeon. We administered 60 mg of ketorolac to one group (ketorolac group, n = 20) and the other group (control group, n = 20) received no pain medication intraoperatively. Postoperative visual analogue pain scores (VAS), analgesic requirements and side effects were examined and compared between two groups. RESULTS: VAS at 6 hours after surgery were significantly less (P<0.05) in the ketorolac group (3.1+/-1.5) than in the control group (6.0+/-1.2) and demerol consumption during the first 6 hours after surgery in the ketorolac group was significantly less (P<0.05) than in the control group (35 mg vs 62.5 mg). The ketorolac group also showed significantly less incidence of urinary retention than the control group (P <0.05). CONCLUSIONS: 60 mg of ketorolac administered during hemorrhoidectomy was partially effective for postoperative pain control and the incidence of urinary retention was significantly reduced.

Factors Influencing Postoperative Urinary Retention after Hemorrhoidectomy / 대한마취과학회지

BACKGROUND: In previous our retrospective study, we concluded that administered fluid volume, duration of operation, operative procedures and anesthetic techniques were the major factors of postoperative urinary retention. However, the administered fluid volume, age, types and duration of the operation confined to hemorrhoidectomy was questioned as a precipitating factor. The high retention rate in spinal anesthesia is also questioned. METHODS: We investigated these possible precipitating factors of urinary retention in healthy patients (n=154) undergoing hemorrhoidectomy. The patients were randomly divided into three different anesthetic techniques: caudal (2% lidocaine 300 mg with 1 : 200,000 epinephrine), spinal (0.5% tetracaine 5 mg with epinephrine 0.1 mg or 5% lidocaine 40 mg) and general (enflurane, N2O, vecuronium). Urinary retentin was searched according to above factors following surgery. RESULTS: The overall urinary retention rate was 46.1%. The retention rate in patients with spinal anesthesia was higher than that in those with other anesthetic techniques (p<0.05). There was no significant difference between patients with lidocaine and tetracaine spinal anesthesia in urinary retention rate. The administered fluid volume in patients with urinary retention was significantly higher than that of patients without retention (p<0.05). Age, duration and types of hemorrhoidectomy did not significantly affect urinary retention rate. CONCLUSIONS: Restriction of fluid administration and avoidance of spinal anesthesia are necessary in reducing postoperative urinary retention following hemorrhoidectomy.