Analgesic Effect of Ropivacaine Combined with Hydromorphone following Surgery for Mixed Hemorrhoids: A Pilot Study.

Background: Postoperative pain is a major adverse effect of surgery for mixed hemorrhoids. We evaluated whether spinal anesthesia with ropivacaine and hydromorphone provided safe and effective analgesia after surgery for mixed hemorrhoids.
Methods: This single-center, double-blind pilot study included patients with mixed hemorrhoids who underwent a procedure for prolapse and hemorrhoids (PPH) and external hemorrhoidectomy under spinal anesthesia at Zhejiang Hospital, China (October 2020 to December 2020). Patients were randomized to a hydromorphone group (spinal anesthesia with 0.5% ropivacaine and 75  μ g hydromorphone) or morphine group (spinal anesthesia with 0.5% ropivacaine and 150  μ g morphine). Pain scores (numerical rating scale), incidences of vomiting and itching, and length of hospital stay (LoS) were recorded at 6, 12, 18, and 24 hours after surgery.
Results: The analysis included 40 patients in each group. Median (interquartile range) pain score in the hydromorphone group was higher than that in the morphine group at 12 hours (1 (0-2] vs. 0 (0-2), p =0.044) but not significantly different between groups at 6 hours (0 (0-1) vs. 0 (0-0) p =0.228), 18 hours (2 (2-3) vs. 2 (1-3) p =0.060) or 24 hours (2 (2-3) vs. 2 (1-3) p =0.081). The hydromorphone group had a lower incidence of pruritus than the morphine group (47.5% vs. 67.5%, p =0.018). There were no significant differences between groups in vomiting incidence or LoS.
Conclusion: In patients with mixed hemorrhoids, spinal anesthesia with ropivacaine/hydromorphone has a comparable analgesic effect and a lower incidence of pruritus during the first 24 hours after surgery than spinal anesthesia with ropivacaine/morphine.
Competing Interests: The authors declare that they have no conflicts of interest regarding the publication of this article.
(Copyright © 2022 Xuejing Luo et al.)