INTRAOPERATIVE USE OF TORADOL(R) FACILITATES OUTPATIENT HEMORRHOIDECTOMY

Pain after hemorrhoidectomy is widely feared by many patients who are mostly still treated with oral/intramuscular narcotics to control thei r pain postoperatively. PURPOSE: in an effort to decrease posthemorrho idectomy pain by applying newer methods of analgesia, a prospective tr ial was conducted to investigate the postoperative analgesic effect of Toradol(R) (ketorolac tromethamine; Syntex Labs, Pale Alto, CA) injec ted into the sphincter muscle at the time of hemorrhoidectomy and tal; en orally during a five-day postoperative period in a group of 24 pati ents (Toradol(R) group). Results were compared with two other groups o f matching patients: one group (narcotics, n = 18) treated with Standa rd postoperative narcotic intramuscular/oral analgesics after overnigh t hospital stay, and a group (SQMP, n = 21) previously treated by one of us with outpatient, subcutaneous infusion of morphine sulfate (Roxa ne Laboratories, Columbus, OH) via a home infusion pump. METHOD: The l ength of hospitalization, severity of postoperative pain and complicat ions, costs, and side effects were analyzed by patient questionnaire a t the time of the first postoperative visit and hospital and clinic re cords were reviewed. Differences between groups were analyzed using St udent's t-test with P < 0.05 bring significant. RESULTS: Subjective pa in response and hospitalization cost were significantly less in the SQ MP group; however, this was at the expense of increased postoperative complications (urinary retention) and side effects (day until first bo wel movement, nausea) although without a decrease in satisfaction rati ng. The Toradol(R) group had pain control equivalent to that of the na rcotics group, a higher satisfaction rating, and suffered no increase in complications relative to either group. Significantly, there was no urinary retention in the Toradol(R) group. CONCLUSION: Postoperative pain after hemorrhoidectomy can be safely controlled as an outpatient using newer methods of pain control. These include both constant-infus ion pain pump or supplemental use of the nonsteroidal analgesic ketoro lac, both of which allow early release of the patient the day of surge ry by diminishing postoperative pain. An important advantage of local injection of ketorolac is the elimination of urinary retention in our study group, probably by blunting the pain reflex response facilitated by prostaglandins, thus allowing safe same-day discharge.