Abstract
OBJECTIVES: Hemorrhoids commonly occur worldwide, and surgical intervention is required in severe cases. However, a method for postoperative pain control is yet to be established. In this study, we developed a caudal epidural anesthesia tube placement method and demonstrated its meaningful outcomes. METHODS: We postoperatively analyzed 85 patients who underwent hemorrhoid surgery at the Sapporo Ishiyama Hospital. Using a computer-generated method, patients were assigned to the caudal epidural tube placement group (E group; n = 47) or without tube placement group (N group; n = 38) and compared using a numeric rating scale (NRS). RESULTS: Goligher classification grade ≥3 severe hemorrhoids were found in 93% of patients in the study. Anal cushion lifting (ACL), a surgical technique requiring no hemorrhoid resection with or without excision (e.g., Milligan-Morgan hemorrhoidectomy), was used. Swelling was observed in 15% of overall patients, but it was controlled with conservative treatment. Postoperative bleeding occurred in one patient in the N group. The mean duration of caudal epidural tube placement was 33.7 h, and there were no adverse events such as infection. The NRS results showed that the E group had a significantly lower mean NRS score at postoperative 24 and 48 h compared with the N group. No apparent rebound pain after tube removal occurred, and the transition to an oral analgesic was smooth and successful. CONCLUSIONS: Our novel method may contribute to the pain management during early periods following hemorrhoidectomy.