Role of Local Infiltration of Methylene Blue as an Analgesic in Stapled Hemorrhoidopexy: A Prospective Study
Background: Stapled hemorrhoidopexy gained popularity due to low postoperative pain. Few patients still complain of postoperative anal pain. Methylene blue (MB) in caudal and epidural anesthesia gives long-term pain relief and has also been used to treat intractable pruritus ani. Objective: Evaluate...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2020-03-01
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| Series: | World Journal of Colorectal Surgery |
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| Online Access: | https://journals.lww.com/10.4103/WJCS.WJCS_20_19 |
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| author | Pranav Mandovra Vishakha Kalikar Prasang Bajaj Roy Patankar |
| author_facet | Pranav Mandovra Vishakha Kalikar Prasang Bajaj Roy Patankar |
| author_sort | Pranav Mandovra |
| collection | DOAJ |
| description | Background:
Stapled hemorrhoidopexy gained popularity due to low postoperative pain. Few patients still complain of postoperative anal pain. Methylene blue (MB) in caudal and epidural anesthesia gives long-term pain relief and has also been used to treat intractable pruritus ani.
Objective:
Evaluate the role of local infiltration of the MB as an analgesic in the procedure for prolapse and hemorrhoids (PPH) surgery.
Design:
Prospective observational study.
Setting:
Tertiary health care center.
Patients and Methods:
Patients with grade-III hemorrhoids were included and were divided into two groups: A and B. Group A received a perianal injection of 2 mL of 1% MB with 10 mL of 25% bupivacaine. Group B received a perianal injection of 2 mL of normal saline with 10 mL of 25% bupivacaine.
Main Outcome Measures:
Patients were followed up prospectively for pain, hospital stay, and complications. Results were noted and compared between the two groups.
Sample Size:
50 patients.
Results:
Group A had significantly lower pain scores on day 3 (mean ± SD 2.08 ± 1.08) and day 7 (mean ± SD 0.64 ± 0.95) as compared to the pain scores on day 3 (mean ± SD 3.92 ± 1.35) (P-value = 0.000) and day 7 (mean ± SD 2.40 ± 1.0) (P-value = 0.000) in group B. Pain scores within first 24 h and day 21 post-surgery were not statistically significant between groups A and B (P-value = 0.286 and 0.19, respectively). Group B required a significantly higher number of both injectable and oral analgesics (mean + SD 4.03 + 0.94) as compared to group A patients (mean + SD 1.97 + 0.81) (P-value = 0.001). 4% of the patients in group B had prolonged hospital stay due to severe pain. Patients in group A also had a significant reduction in their requirement of analgesics. None of the patients who received MB had any local or systemic allergic reactions.
Conclusion:
Local infiltration of MB may be used as an effective analgesic in PPH patients without any increase in morbidity.
Limitations:
Single-center study with a small sample size.
Conflict of Interest:
None. |
| format | Article |
| id | doaj-art-c02e7118bd1f44dfb4a587f2cba1dc47 |
| institution | DOAJ |
| issn | 1941-8213 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | World Journal of Colorectal Surgery |
| spelling | doaj-art-c02e7118bd1f44dfb4a587f2cba1dc472025-08-20T03:13:50ZengWolters Kluwer Medknow PublicationsWorld Journal of Colorectal Surgery1941-82132020-03-0191101310.4103/WJCS.WJCS_20_19Role of Local Infiltration of Methylene Blue as an Analgesic in Stapled Hemorrhoidopexy: A Prospective StudyPranav MandovraVishakha KalikarPrasang BajajRoy PatankarBackground: Stapled hemorrhoidopexy gained popularity due to low postoperative pain. Few patients still complain of postoperative anal pain. Methylene blue (MB) in caudal and epidural anesthesia gives long-term pain relief and has also been used to treat intractable pruritus ani. Objective: Evaluate the role of local infiltration of the MB as an analgesic in the procedure for prolapse and hemorrhoids (PPH) surgery. Design: Prospective observational study. Setting: Tertiary health care center. Patients and Methods: Patients with grade-III hemorrhoids were included and were divided into two groups: A and B. Group A received a perianal injection of 2 mL of 1% MB with 10 mL of 25% bupivacaine. Group B received a perianal injection of 2 mL of normal saline with 10 mL of 25% bupivacaine. Main Outcome Measures: Patients were followed up prospectively for pain, hospital stay, and complications. Results were noted and compared between the two groups. Sample Size: 50 patients. Results: Group A had significantly lower pain scores on day 3 (mean ± SD 2.08 ± 1.08) and day 7 (mean ± SD 0.64 ± 0.95) as compared to the pain scores on day 3 (mean ± SD 3.92 ± 1.35) (P-value = 0.000) and day 7 (mean ± SD 2.40 ± 1.0) (P-value = 0.000) in group B. Pain scores within first 24 h and day 21 post-surgery were not statistically significant between groups A and B (P-value = 0.286 and 0.19, respectively). Group B required a significantly higher number of both injectable and oral analgesics (mean + SD 4.03 + 0.94) as compared to group A patients (mean + SD 1.97 + 0.81) (P-value = 0.001). 4% of the patients in group B had prolonged hospital stay due to severe pain. Patients in group A also had a significant reduction in their requirement of analgesics. None of the patients who received MB had any local or systemic allergic reactions. Conclusion: Local infiltration of MB may be used as an effective analgesic in PPH patients without any increase in morbidity. Limitations: Single-center study with a small sample size. Conflict of Interest: None.https://journals.lww.com/10.4103/WJCS.WJCS_20_19anal painhemorrhoidectomymethylene bluepphstapler |
| spellingShingle | Pranav Mandovra Vishakha Kalikar Prasang Bajaj Roy Patankar Role of Local Infiltration of Methylene Blue as an Analgesic in Stapled Hemorrhoidopexy: A Prospective Study World Journal of Colorectal Surgery anal pain hemorrhoidectomy methylene blue pph stapler |
| title | Role of Local Infiltration of Methylene Blue as an Analgesic in Stapled Hemorrhoidopexy: A Prospective Study |
| title_full | Role of Local Infiltration of Methylene Blue as an Analgesic in Stapled Hemorrhoidopexy: A Prospective Study |
| title_fullStr | Role of Local Infiltration of Methylene Blue as an Analgesic in Stapled Hemorrhoidopexy: A Prospective Study |
| title_full_unstemmed | Role of Local Infiltration of Methylene Blue as an Analgesic in Stapled Hemorrhoidopexy: A Prospective Study |
| title_short | Role of Local Infiltration of Methylene Blue as an Analgesic in Stapled Hemorrhoidopexy: A Prospective Study |
| title_sort | role of local infiltration of methylene blue as an analgesic in stapled hemorrhoidopexy a prospective study |
| topic | anal pain hemorrhoidectomy methylene blue pph stapler |
| url | https://journals.lww.com/10.4103/WJCS.WJCS_20_19 |
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