Everyone Dreads Hemorrhoid Surgery! A Study by Surgeons in Vermont Shows A Way to Change This

Read a newly published study in the July issue of Diseases of the Colon and Rectum describing the first trial of its kind to address the value of providing preemptive analgesia to anorectal surgery procedures.


Newswise — The idea of blocking pain receptors before surgery, something known as “preemptive analgesia,” is not a new concept. This has been studied in many different fields, including orthopedic, urologic, and gynecologic surgery. Physicians from the University of Vermont Medical Center in Burlington undertook a prospective, randomized, double-blinded, placebo-controlled trial to see whether this technique could help reduce pain and narcotic use following common anal rectal surgical procedures. Patients undergoing surgery for common anal rectal conditions such as hemorrhoids, anal fissures, fistulas, or warts were asked to participate in this study. If they gave their consent, they were then randomized either to receive standard treatment and placebo or the “preemptive analgesia” group.  In the latter group, patients received 2 extra strength Tylenol tablets and 600 mg gabapentin before surgery in addition to receiving an intravenous dose of steroid and ketamine during surgery. All treatment was otherwise identical. The patients in the preemptive analgesia group had significantly less pain while in the recovery room as well as eight hours after surgery. They also used less narcotic medication during these times.

This study is especially timely considering the current opioid epidemic, problems with opioid overuse, and associated cost complications.  More studies such as this one showing satisfactory and indeed improved pain control without narcotic are needed.

Citation: Van Backer J, Jordan MR, Leahy DT Moore JS, Callas P, Dominick T, Cataldo PA. Preemptive analgesia decreases pain following anorectal surgery: a prospective, randomized, double-blinded, placebo-controlled trial. Dis Colon Rectum 2018;61:824-829.

To request a copy of the article, please send an email to Margaret Abby, Managing Editor, Diseases of the Colon and Rectum (dcrjournalmanagingeditor@gmail.com)

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