The objective of this retrospective study was to examine the effects of an intraoperative injection of liposome bupivacaine on the quality and duration of postsurgical pain control, patient satisfaction, and opioid use in a cohort of patients undergoing hemorrhoidectomy in an outpatient setting. Patients underwent ambulatory hemorrhoidectomy conducted by a single surgeon. Liposome bupivacaine 266 mg/20 mL was administered via infiltration at the end of surgery. After discharge, pain-related outcomes were assessed via telephone interviews. Outcomes of interest included first onset of pain after surgery, patient-reported pain intensity (0 = no pain; 10 = worst pain imaginable), time to first use of orally administered opioids after surgery, number of opioid tablets consumed postsurgery, and patient’s satisfaction with postsurgical pain control. A total of 95 patients were included; the average number of hemorrhoids excised was 3.0 (median, 2.7) per patient. Mean time to first onset of pain after surgery was 36 hours; mean time to first consumption of postsurgical opioids was 38 hours. Mean pain intensity scores remained <5 through 72 hours after surgery. The average number of opioid analgesic tablets consumed after surgery was 12.4; 13% (12/95) of patients required no postsurgical opioids. Seventy-five percent of patients reported being “very satisfied” or “perfectly satisfied” with their overall pain control. No liposome bupivacaine-related adverse events were observed. A single intraoperative injection of liposome bupivacaine safely facilitated ambulatory hemorrhoidectomy, eliminated the need for intravenous opioids, minimized opioid use, and was associated with high levels of patient satisfaction.
References
[1]
Rivadeneira, D.E., Steele, S.R., Ternent, C., Chalasani, S., Buie, W.D. and Rafferty, J.L. (2011) Practice Parameters for the Management of Hemorrhoids (Revised 2010). Diseases of the Colon & Rectum, 54, 1059-1064.
http://dx.doi.org/10.1097/DCR.0b013e318225513d
Gorfine, S.R., Onel, E., Patou, G. and Krivokapic, Z.V. (2011) Bupivacaine Extended-Release Liposome Injection for Prolonged Postsurgical Analgesia in Patients Undergoing Hemorrhoidectomy: A Multicenter, Randomized, Double- Blind, Placebo-Controlled Trial. Diseases of the Colon & Rectum, 54, 1552-1559.
http://dx.doi.org/10.1097/DCR.0b013e318232d4c1
[4]
Haas, E., Onel, E., Miller, H., Ragupathi, M. and White, P.F. (2012) A Double-Blind, Randomized, Active-Controlled Study for Post-Hemorrhoidectomy Pain Management with Liposome Bupivacaine, a Novel Local Analgesic Formulation. The American Surgeon, 78, 574-581.
[5]
Naseem, A., Harada, T., Wang, D., et al. (2012) Bupivacaine Extended Release Liposome Injection Does Not Prolong QTc Interval in a Thorough QT/QTc Study in Healthy Volunteers. Journal of Clinical Pharmacology, 52, 1441-1447.
http://dx.doi.org/10.1177/0091270011419853
[6]
Bergese, S.D., Onel, E., Morren, M. and Morganroth, J. (2012) Bupivacaine Extended-Release Liposome Injection Exhibits a Favorable Cardiac Safety Profile. Regional Anesthesia and Pain Medicine, 37, 145-151.
http://dx.doi.org/10.1097/AAP.0b013e31823d0a80
[7]
Milligan, E.T.C. and Morgan, C.N. (1937) Surgical Anatomy of the Anal Canal and Operative Treatment of Haemorrhoids. Lancet, 2, 1119-1124. http://dx.doi.org/10.1016/S0140-6736(00)88465-2
[8]
Ferguson, J.A. and Heaton, J.R. (1959) Closed Hemorrhoidectomy. Diseases of the Colon & Rectum, 2, 176-179.
http://dx.doi.org/10.1007/BF02616713
[9]
Ho, Y.H., Seow-Choen, F., Tan, M. and Leong, A.F. (1997) Randomized Controlled Trial of Open and Closed Haemorrhoidectomy. British Journal of Surgery, 84, 1729-1730. http://dx.doi.org/10.1002/bjs.1800841223
[10]
Arbman, G., Krook, H. and Haapaniemi, S. (2000) Closed Vs. Open Hemorrhoidectomy—Is There Any Difference? Diseases of the Colon & Rectum, 43, 31-34. http://dx.doi.org/10.1007/BF02237240
[11]
Salfi, R. (2009) A New Technique for Ambulatory Hemorrhoidal Treatment. Coloproctology, 31, 99-103.
http://dx.doi.org/10.1007/s00053-009-0009-7
[12]
Wang, J.Y., Chang-Chien, C.R., Chen, J.S., Lai, C.R. and Tang, R.P. (1991) The Role of Lasers in Hemorrhoidectomy. Diseases of the Colon & Rectum, 34, 78-82. http://dx.doi.org/10.1007/BF02050213
[13]
Armstrong, D.N., Frankum, C., Schertzer, M.E., Ambroze, W.L. and Orangio, G.R. (2002) Harmonic Scalpel Hemorrhoidectomy: Five Hundred Consecutive Cases. Diseases of the Colon & Rectum, 45, 354-359.
http://dx.doi.org/10.1007/s10350-004-6182-4
[14]
Chung, C.C., Ha, J.P., Tai, Y.P., Tsang, W.W. and Li, M.K. (2002) Double-Blind, Randomized Trial Comparing Harmonic Scalpel Hemorrhoidectomy, Bipolar Scissors Hemorrhoidectomy, and Scissors Excision: Ligation Technique. Diseases of the Colon & Rectum, 45, 789-794. http://dx.doi.org/10.1007/s10350-004-6299-5
[15]
Thorbeck, C.V. and Montes, M.F. (2002) Haemorrhoidectomy: Randomised Controlled Clinical Trial of Ligasure Compared with Milligan-Morgan Operation. European Journal of Surgery, 168, 482-484.
http://dx.doi.org/10.1080/110241502321116497
[16]
Senagore, A.J., Singer, M., Abcarian, H., et al. (2004) A Prospective, Randomized, Controlled Multicenter Trial Comparing Stapled Hemorrhoidopexy and Ferguson Hemorrhoidectomy: Perioperative and One-Year Results. Diseases of the Colon & Rectum, 47, 1824-1836. http://dx.doi.org/10.1007/s10350-004-0694-9
[17]
De Nardi, P., Capretti, G., Corsaro, A. and Staudacher, C. (2014) A Prospective, Randomized Trial Comparing the Short- and Long-Term Results of Doppler-Guided Transanal Hemorrhoid Dearterialization with Mucopexy versus Excision Hemorrhoidectomy for Grade III Hemorrhoids. Diseases of the Colon & Rectum, 57, 348-353.
http://dx.doi.org/10.1097/DCR.0000000000000085
[18]
Chester, J.F., Stanford, B.J. and Gazet, J.C. (1990) Analgesic Benefit of Locally Injected Bupivacaine after Hemorrhoidectomy. Diseases of the Colon & Rectum, 33, 487-489. http://dx.doi.org/10.1007/BF02052143
[19]
Jirasiritham, S., Tantivitayatan, K. and Jirasiritham, S. (2004) Perianal Blockage with 0.5% Bupivacaine for Postoperative Pain Relief in Hemorrhoidectomy. Journal of the Medical Association of Thailand, 87, 660-664.
[20]
Karanlik, H., Akturk, R., Camlica, H. and Asoglu, O. (2009) The Effect of Glyceryl Trinitrate Ointment on Posthemorrhoidectomy Pain and Wound Healing: Results of a Randomized, Double-Blind, Placebo-Controlled Study. Diseases of the Colon & Rectum, 52, 280-285. http://dx.doi.org/10.1007/DCR.0b013e31819c98a7
[21]
Wasvary, H.J., Hain, J., Mosed-Vogel, M., Bendick, P., Barkel, D.C. and Klein, S.N. (2001) Randomized, Prospective, Double-Blind, Placebo-Controlled Trial of Effect of Nitroglycerin Ointment on Pain after Hemorrhoidectomy. Diseases of the Colon & Rectum, 44, 1069-1073. http://dx.doi.org/10.1007/BF02234622
[22]
Perrotti, P., Dominici, P., Grossi, E., Cerutti, R. and Antropoli, C. (2010) Topical Nifedipine with Lidocaine Ointment versus Active Control for Pain after Hemorrhoidectomy: Results of a Multicentre, Prospective, Randomized, Double- Blind Study. Canadian Journal of Surgery, 53, 17-24.
[23]
Silverman, R., Bendick, P.J. and Wasvary, H.J. (2005) A Randomized, Prospective, Double-Blind, Placebo-Controlled Trial of the Effect of a Calcium Channel Blocker Ointment on Pain after Hemorrhoidectomy. Diseases of the Colon & Rectum, 48, 1913-1916. http://dx.doi.org/10.1007/s10350-005-0135-4
[24]
Nicholson, T.J. and Armstrong, D. (2004) Topical Metronidazole (10 Percent) Decreases Posthemorrhoidectomy Pain and Improves Healing. Diseases of the Colon & Rectum, 47, 711-716. http://dx.doi.org/10.1007/s10350-003-0129-z
[25]
Ala, S., Saeedi, M., Eshghi, F. and Mirzabeygi, P. (2008) Topical Metronidazole Can Reduce Pain after Surgery and Pain on Defecation in Postoperative Hemorrhoidectomy. Diseases of the Colon & Rectum, 51, 235-238.
http://dx.doi.org/10.1007/s10350-007-9174-3
[26]
Gupta, P.J., Heda, P.S., Kalaskar, S. and Tamaskar, V.P. (2008) Topical Sucralfate Decreases Pain after Hemorrhoidectomy and Improves Healing: A Randomized, Blinded, Controlled Study. Diseases of the Colon & Rectum, 51, 231- 234. http://dx.doi.org/10.1007/s10350-007-9092-4
[27]
Davies, J., Duffy, D., Boyt, N., Aghahoseini, A., Alexander, D. and Leveson, S. (2003) Botulinum Toxin (Botox) Reduces Pain after Hemorrhoidectomy: Results of a Double-Blind, Randomized Study. Diseases of the Colon & Rectum, 46, 1097-1102. http://dx.doi.org/10.1007/s10350-004-7286-6
[28]
Sim, H.L. and Tan, K.Y. (2014) Randomized Single-Blind Clinical Trial of Intradermal Methylene Blue on Pain Reduction after Open Diathermy Haemorrhoidectomy. Colorectal Disease, 16, O283-O287.
http://dx.doi.org/10.1111/codi.12587
[29]
O’Donovan, S., Ferrara, A., Larach, S. and Williamson, P. (1994) Intraoperative Use of Toradol Facilitates Outpatient Hemorrhoidectomy. Diseases of the Colon & Rectum, 37, 793-799. http://dx.doi.org/10.1007/BF02050144
[30]
Ilfeld, B.M., Morey, T.E. and Enneking, F.K. (2003) Portable Infusion Pumps Used for Continuous Regional Analgesia: Delivery Rate Accuracy and Consistency. Regional Anesthesia and Pain Medicine, 28, 424-432.
http://dx.doi.org/10.1097/00115550-200301000-00004
[31]
Chiu, J.H., Chen, W.S., Chen, C.H., et al. (1999) Effect of Transcutaneous Electrical Nerve Stimulation for Pain Relief on Patients Undergoing Hemorrhoidectomy: Prospective, Randomized, Controlled Trial. Diseases of the Colon & Rectum, 42, 180-185. http://dx.doi.org/10.1007/BF02237124
[32]
Baptista, J.F., Gomez, R.S., Paulo, D.N., Carraretto, A.R., Brocco, M.C. and Silva, J.J. (2014) Epidural Anesthesia with Ropivacaine with or without Clonidine and Postoperative Pain in Hemorrhoidectomies. Acta Cirurgica Brasileira, 29, 201-208. http://dx.doi.org/10.1590/S0102-86502014000300009
[33]
Moreira Jr., H., Moreira, J.P., Isaac, R.R., et al. (2014) Morphine Spinal Block Anesthesia in Patients Who Undergo an Open Hemorrhoidectomy: A Prospective Analysis of Pain Control and Postoperative Complications. Annals of Coloproctology, 30, 135-140. http://dx.doi.org/10.3393/ac.2014.30.3.135
[34]
Goligher, J.C., Graham, N.G., Clark, C.G., De Dombal, F.T. and Giles, G. (1969) The Value of Stretching the Anal Sphincters in the Relief of Post-Haemorrhoidectomy Pain. British Journal of Surgery, 56, 859-861.
http://dx.doi.org/10.1002/bjs.1800561117
[35]
Kanellos, I., Zacharakis, E., Christoforidis, E., et al. (2005) Usefulness of Lateral Internal Sphincterotomy in Reducing Postoperative Pain after Open Hemorrhoidectomy. World Journal of Surgery, 29, 464-468.
http://dx.doi.org/10.1007/s00268-004-7432-2
[36]
Data on File (2014) Unpublished Results. Pacira Pharmaceuticals, Inc., Parsippany, NJ.
