Efficacy of Paracetamol Versus Tramadol Plus Ketorolac for Pain Control after Hemorrhoidectomy: A Prospective Randomized Trial

Abstract

Background Postoperative pain after haemorrhoidectomy is the complication most feared by patients and remains one of the most difficult for physicians to manage. Suboptimal pain control may be associated with a prolonged hospital stay and higher costs of hospitalization. Methods Fifty patients with grades III and IV hemorrhoids who underwent conventional Milligan-Morgan haemorrhoidectomy were randomly assigned to receive either 1,000 mg intravenous (iv) paracetamol infusion 3 times daily (group I, 25 patients), or iv constant- infusion pump of tramadol plus ketorolac (group II, 25 patients). Pain was evaluated according to the visual analogue scale (VAS) at 2, 12, 24, 36 and 48 h postoperatively. Severe bleeding and length of hospital stay were recorded. Results The two groups were homogeneous with respect to sex, age and grade of haemorrhoids. No pain was recorded at 2 h in both groups due to resistance of the analgesic effect of the spinal anesthesia. Group II had a significant reduction in VAS scores at 12, 24, 36 h compared with group I (-52.7, -76.0, - 67.5 % respectively, p<0.001). At 48 h, 23 patients (92 %) in group II versus 11 patients (44 %) in group I were discharged (p = 0.001). There were two cases of bleeding requiring surgery in group I. Conclusions Pain after hemorrhoidectomy is more likely to be controlled by a constant-infusion pump of tramadol plus ketorolac than by interspersed infusion of paracetamol. There is no increased risk of hemorrhage using a nonsteroidal anti-inflammatory drugs for pain control. A better pain control is associated with a shorter hospital stay.