SUBCUTANEOUS MORPHINE PUMP FOR POSTOPERATIVE HEMORRHOIDECTOMY PAIN MANAGEMENT

PURPOSE: Many anorectal procedures are currently being performed on an outpatient basis, hemorrhoidectomy being the exception because of the need for parenteral narcotics postoperatively. We investigated the ef fectiveness of a subcutaneous morphine pump (SQMP) for out-patient pos themorrhoidectomy pain control. METHODS: In Phase 1 of our study, 22 p atients undergoing radical hemorrhoidectomy were started on an SQMP pr otocol postoperatively. Twenty-nine patients received conventional pos toperative narcotic dosing. In Phase 2, 19 patients enrolled in an SQM P protocol underwent hemorrhoidectomy in an ambulatory setting. Length of hospitalization, catheterization rate, and pain control were evalu ated. RESULTS: In Phase 1, zero patients in the study group and two in the control group required additional hospitalization beyond 23 hours for pain control. The rates of catheterization were similar between t he two groups. Pain control was considered satisfactory in 21 of 22 st udy patients. There was no correlation between pain level and morphine dose. Eighteen of 22 patients experienced minor side effects, necessi tating pump removal in two patients. In Phase 2, 18 of 19 patients on the SQMP were discharged from the recovery room. Cost analysis shows t he combination of outpatient hemorrhoidectomy and the SQMP to be cost- effective in comparison with an inpatient stay. CONCLUSIONS: The SQMP enables hemorrhoidectomy to be done on an outpatient basis. It provide s effective pain control, enjoys high patient acceptance, and is cost- effective.