What is the clinical evidence from this study?

Study design: Observational. Population: Benign perianal diseases (hemorrhoids and anorectal fistula) (n=217). Intervention: Short-stay anorectal surgery. Primary outcome: VAS score from days 1 to 10 after the operation.

November 22, 2022Open Access

Pain Trajectory after Short-Stay Anorectal Surgery: A Prospective Observational Study

Key Result

After short-stay anorectal surgery, patients exhibited three distinct pain trajectories (high-low 57.0%, low 23.3%, low-moderate-low 19.7%), with 62.7% maintaining moderate-to-high pain for 7 days.

Study Design

Type

Observational (n=217)

Multicenter

Structured PICO

Population

217 patients undergoing elective surgery for benign perianal diseases (hemorrhoidectomy and anal fistulectomy), age >18 years, expected hospitalisation >48 h, ASA class I-II. Mean age 41.0, 68.7% male, based in China.

Intervention

Short-stay anorectal surgery (hemorrhoidectomy or anal fistulectomy) with postoperative pain assessment

Outcome

VAS score from days 1 to 10 after the operationpatient reported

Three distinct pain trajectories exist after short-stay anorectal surgery, with over 60% of patients maintaining moderate to severe pain within 7 days postoperatively, highlighting the need for improved personalized analgesia.

Limitations

Single-centre design may limit the generalisability of the findings
Sample size limited the ability to make stronger inferences about relevant factors influencing pain trajectory

Abstract

Abstract OBJECTIVE: The dense distribution of perianal nerves, having to defecate, and underappreciated analgesia make the postoperative pain of anorectal surgery significantly serious. However, the evolution of pain after anorectal surgery has not been well characterized. The main objective is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery.The main objective is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery. Methods: The study included 217 patients who underwent anorectal surgery for hemorrhoids and anorectal fistula. The VAS pain scale was used to record the pain across postoperative days 1 through 10. The primary analysis used group-based trajectory modeling to estimate the trajectory of postoperative pain. Secondary analysis examined the relationships between sociodemographic, types of surgery, preoperative anxiety score and pain behavior score, and postoperative analgesics and pain trajectories. RESULTS : Three distinct postoperative pain trajectories were determined. Many patients (57.0%) belonged to the high-low group, followed by the low group (23.3%) and the low-moderate-low group (19.7%). Moreover, 62.7% of patients reported pain stable and sustained moderate-to-high over the first 7 days after surgery, while 97% had decreased to mild pain by the 10th day. Hemorrhoidectomy (odds ratio, 0.15), higher anxiety (odds ratio, 3.26), and higher preoperative pain behavior score (odds ratio, 3.15), were associated with an increased likelihood of being in the high pain trajectory in multivariate analysis. The pain trajectory group was related to postoperative analgesic use (P<0.001), with the high-low group needing more nonsteroidal analgesics. CONCLUSIONS: There are three obvious pain trajectories after anorectal surgery for hemorrhoids and anal fistula, including an unreported low-moderate-low type. More than 60% of patients maintained moderate and severe pain within 7 days after the operation. These postoperative pain trajectories were predominantly defined by surgery factors and patient factors.

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Discussion

Institutions

Shanghai University of Traditional Chinese Medicine

Shuguang Hospital

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