Preemptive Analgesia Decreases Pain Following Anorectal Surgery: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial
*Justin T. Van Backer, MD1,4, *Matthew R. Jordan, MD2, *Danielle T. Leahy, MD3, Jesse S. Moore, MD4, *Peter Callas, PhD4,5, *Timothy Dominick, MD3, *Peter A. Cataldo, MD4
1Department of General Surgery, Albany Medical Center, Albany, NY; 2Department of Emergency Medicine, Naval Medical Center, Portsmouth, VA; 3Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT; 4Department of Surgery, University of Vermont Medical Center, Burlington, VT; 5Department of Statistics, University of Vermont, Burlington, VT
Objective: To evaluate the effectiveness of preemptive analgesia in decreasing postoperative pain following anorectal surgery.
Design: Randomized, double-blinded, placebo-controlled clinical trial.
Setting: University of Vermont Medical Center, a tertiary care referral center in Burlington, VT.
Patients: Age greater than 18 years, American Society of Anesthesiology Physical Status Classes I, II, or III, undergoing surgery for anal fissure, fistula, or condyloma, or hemorrhoids.
Interventions: Preoperative acetaminophen and gabapentin followed by intravenous ketamine and dexamethasone before incision compared with oral placebos.
Main Outcome Measures:Postoperative pain scores, percentage of patients utilizing breakthrough narcotics, and rates of side effects.
Results: Ninety patients were enrolled. Due to patient withdrawal, screen failures, and loss to follow up, 61 patients were analyzed (30 in the active group and 31 in the control group). Patients in the active group had significantly less pain in the post anesthesia care unit (PACU) and at 8 hours postoperatively. Significantly fewer participants in the active group used narcotics in PACU and at 8 hours postoperatively. Average pain scores were excellent for both groups. There was no difference in the number of side effects.
Conclusions: Preemptive analgesia is safe and results in decreased postoperative pain and fewer patients requiring narcotics in the early postoperative setting following anorectal surgery. It should be implemented by surgeons performing these procedures.
