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.

Urinary Retention after Perianal Operation / 대한마취과학회지

BACKGROUND: Urinary retention is the most common complication after perianal surgery. The authors tried to evaluate the influence of the types and duration of the operation and the types of anesthesia on the incidence of urinary retention. METHODS: The medical and anesthetic records of 106 patients were reviewed retrospectively. They got perianal surgerys after recieving one of the regional blocks; 0.5% hyperbaric bupivacaine 5~8 mg intrathecally, 0.5% hyperbaric tetracaine 5~8 mg intrathecally, or 2% lidocaine 300 mg with epinephrine 5 g/ml caudally. The incidences of urinary retention were compared with each other by Chi-square test and Student t-test, according to the above mentioned points. RESULTS: Fifty percent of these patients underwent urinary catheterization. The incidence of urinary retention after hemorrhoidectomy (56.6%) was higher than that of other anorectal procedures (p0.05, Chi-square test), but the difference between spinal and caudal anesthesia was slightly significant (p<0.05, Chi-square test), i.e. the incidence of urinary retention after caudal anesthesia was low. CONCLUSIONS: Short duration of operation, less traumatized perianal surgery, and caudal anesthesia are thought to lead to the lower incidence of urinary retention.

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.