New Trials in Iraqi Hospitals to Manage Pain After Excisional Hemorrhoidectomy

Hasan Asaad Ismael; Ghassan Ali Al-Kizwini; Mohammed Hussein Assi; Ahmed Riyad  Laibee; Lina Abdulmuttalib Salih; Aeshah Makttoof Al-Khafaji; Nuha Abdulmunen Al-Sabbagh

doi:10.54133/ajms.v9i1.2156

Authors

Hasan Asaad Ismael Department of Anaesthesia, Shaikh Zayed Hospital, Baghdad, Iraq
Ghassan Ali Al-Kizwini Department of Surgery, College of Medicine, Mustansiriyah University, Baghdad, Iraq
Mohammed Hussein Assi Department of Human Anatomy, College of Medicine, Mustansiriyah University, Baghdad, Iraq https://orcid.org/0000-0002-9852-8799
Ahmed Riyad Laibee Department of General Surgery, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq
Lina Abdulmuttalib Salih Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
Aeshah Makttoof Al-Khafaji Department of Gynaecology and Obstetrics, Al-Khadhraa Private Hospital, Baghdad, Iraq
Nuha Abdulmunen Al-Sabbagh Department of Gynaecology and Obstetrics, Al-Khadhraa Private Hospital, Baghdad, Iraq

DOI:

https://doi.org/10.54133/ajms.v9i1.2156

Keywords:

Analgesia, Excisional hemorrhoidectomy, Postoperative pain control

Abstract

Background: Excisional hemorrhoidectomy is well-documented to be the best operation for high-grade hemorrhoids as well as complicated hemorrhoids. Yet, postoperative pain is still an exciting problem. Objective: To identify the best synergistic pharmacological mode used for reducing post-excisional hemorrhoidectomy pain. Methods: In a randomized study, 400 patients attending Al-Khadraa' Private Hospital, Baghdad, during the period from June 2022 to January 2024 were allocated into 4 groups (100 in each) according to type of anesthesia and analgesia at intraoperative as well as postoperative management. All underwent excisional hemorrhoidectomy according to the surgeon’s decision. Group I received paracetamol with nefopam; Group II received paracetamol, nefopam, ketamine, and fentanyl; Group III received paracetamol, nefopam, ketamine, fentanyl, and tramadol; and Group IV received paracetamol, nefopam, fentanyl, tramadol, and pethidine. Results: Group I reported the highest pain scores across all time points. Group II and Group III showed moderate improvement in pain control. Group IV demonstrated the lowest pain scores throughout, with a higher percentage of patients reporting minimal or no pain. Data analysis revealed a significant difference in pain scores between groups, and Group IV had significantly lower pain levels compared to the other groups. Conclusions: Though there are dissimilarities in the drug methodology in different studies, some Iraqi strategies to reduce post-hemorrhoidectomy pain are presented in this work; however, the combination of paracetamol, nefopam, fentanyl, tramadol, and pethidine had the best effect.

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