Hemorrhoids Update Review

Regardless of the excisional technique used for the treatment of advanced hemorrhoids, the key to effective patient management is avoiding postoperative complications. Pain is the most frequent complication and the most feared sequela of the procedure from the patient’s perspective. A variety of analgesic regimens have been recommended, usually consisting of a combination of oral and parenteral narcotics.The use of local infiltration of bupivicaine into the wounds and perianal skin has been variably successful in long-term pain reduction.Conversely, ketorolac has demonstrated considerable efficacy in the management of posthemorrhoidectomy pain.The use of alternative administration routes for narcotics by either patch or subcutaneous pump has been successful in controlling pain, but the management of these routes of administration can be risky in the outpatient setting because of the risk of narcotic-induced respiratory depression. The most appropriate regimen after outpatient hemorrhoidectomy appears to be the intraoperative use of ketorolac, sufficient doses of oral narcotic analgesics for home administration, and supplementation of the narcotics with oral nonsteroidal medication.