Diseases of the colon and rectum
-
Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoids.
Forty-nine consecutive patients with symptomatic prolapsed hemorrhoids were prospectively randomized for conventional scissors excision with ligation (Group A; n = 16) or diathermy excision without ligation (Group B; n = 33). The median time taken to complete the procedure was 20 minutes (range, 10-40 minutes) and 10 minutes (range, 5-35 minutes) in Groups A and B, respectively (P < 0.05). Length of hospital stay was similar in both groups, with a median of three days and a range of two to five days. ⋯ There was no statistical difference in the severity of postoperative pain between the two groups. The use of postoperative oral analgesics was significantly lower in Group B (P < 0.02), but there was no significant difference in the demand for intramuscular or topical analgesics. Diathermy excision of hemorrhoids is significantly faster than scissors excision, there is less bleeding, the vascular pedicles need not be ligated, and there is significant reduction in the requirement for oral analgesics postoperatively without any increase in early or late postoperative complications.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A randomized trial comparing direct current therapy and bipolar diathermy in the outpatient treatment of third-degree hemorrhoids.
Fifty patients with third-degree hemorrhoids were randomized to receive outpatient treatment with either bipolar diathermy or direct current therapy. Direct current therapy was used to treat 26 patients and bipolar diathermy was used to treat 24 patients. ⋯ Both treatments are effective in the outpatient management of large, prolapsing hemorrhoids. Bipolar diathermy is less time consuming and better tolerated.
-
Randomized Controlled Trial Clinical Trial
Analgesic benefit of locally injected bupivacaine after hemorrhoidectomy.
The analgesic efficacy of locally injected bupivacaine was studied in 40 patients undergoing hemorrhoidectomy. After a standard Milligan-Morgan hemorrhoidectomy, 40 age- and sex-matched patients were randomized to receive either 0.5 percent bupivacaine (1.5 mg/kg) in adrenaline solution (1:200,000) injected into the perianal area, or equivalent volumes of adrenaline solution. ⋯ Although the median time interval between surgery and first analgesic demand was nearly four times greater for patients receiving bupivacaine compared with adrenaline solution, there was no difference in the levels of pain recorded or in the overall opiate requirements. Local injection of bupivacaine after hemorrhoidectomy provides initial pain relief, but patients do not obtain an overall analgesic benefit.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled analgesia vs. conventional intramuscular analgesia following colon surgery.
Though patient-controlled analgesia (PCA) has been in use for over a decade, it has been popularized only recently. Conventional techniques of intermittent intramuscular (IM) administration of analgesia have fallen short of meeting the needs of patients following major abdominal surgery. This has prompted a search for methods to improve postoperative pain management. ⋯ A comparison of the efficacy of analgesia and extent of sedation using these approaches shows that PCA allows for analgesia with less sedation and less drug requirement than that of IM administration. No differences were noted in postoperative duration of ileus, duration of hospitalization, and total hospital costs. This study confirms the safety and efficacy of PCA, and should be considered the current optimal method of controlling pain following major colonic surgery.