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Comparison of Surgical Results of Hemorrhoidectomy under Intravenous General Anesthesia and Heavy Sedation

比較痔瘡切除術在靜脈全身麻醉與朦朧麻醉下之手術結果

摘要


Purpose. The purpose of this study is to compare surgical results, including operation time, time spent in the operating room, pain score, complications, recurrence, and patient satisfaction between two different anesthetic methods for patients undergoing hemorrhoidectomy. Methods. We retrospectively studied medical records of 64 consecutive patients who were diagnosed as fourth-degree hemorrhoids and underwent surgical treatment in our institute. Thirty patients underwent the procedure under intravenous general anesthesia with perianal anesthetics infiltration (Group 1) and thirty four patients under heavy sedation (intramuscular injections of meperidine and midazolam) with perianal anesthetics infiltration (Group 2). Both groups were compared in the areas of demographics, surgical features, pain score, complications, recurrence, and patient satisfaction. Results. There were no significant difference between group 1 and group 2 in patient age (mean age 41 vs. 43 years, p = 0.593), gender (male vs. female was 13:17 vs. 19:15, p = 0.316), ASA grade (27 ASA I and 3 ASA II in group 1; 29 ASA I and 5 ASA II in group 2, p = 0.713), hemoglobin level (12.2 vs. 12.4 g/dl, p = 0.711), bleeding time value (4.1 vs. 3.9 min, p = 0.658) and duration of follow-up (4.3 vs. 4.4 months, p = 0.703). There was no incident of anesthetic associated complications occurred in both groups. All patients tolerated the hemorrhoidectomy in the prone jackknife position. Therewere also no statistic significance between both groups in procedure time (36.3 vs. 33.2 min, p = 0.223), early or late complications (p = 0.940), duration of hospital stay (2.9 vs. 2.7 days, p = 0.489), pain score on the morning of the first postoperative day (pain score of 5.1 vs. 5.3, p = 0.524) and the postoperative consumption of analgesics use (meperidine use of 105mg and 110mg per person in group 1 and group 2 respectively, p = 0.585). However, the mean time spent in the operating room was significant longer in Group 1 than in Group 2 (61.5 vs. 41.7 min, p < 0.05). Pain score during the operation was significant higher in Group 2 (pain score of 0.5 vs. 6.2, p < 0.05). Patient satisfaction level was superior in Group 1 (satisfied or very satisfied: 25/30 in group 1 vs. 14/34 in group 2, p = 0.007). Conclusion. Both anestheticmethods for hemorrhoidectomy were safe and effectivewithout significant difference in postoperative complications and recurrence. However, patients with intravenous general anesthesia needed more operating room time than those with heavy sedation, but it bears with a significantly lower pain score during the operation and a better satisfaction level.

並列摘要


Purpose. The purpose of this study is to compare surgical results, including operation time, time spent in the operating room, pain score, complications, recurrence, and patient satisfaction between two different anesthetic methods for patients undergoing hemorrhoidectomy. Methods. We retrospectively studied medical records of 64 consecutive patients who were diagnosed as fourth-degree hemorrhoids and underwent surgical treatment in our institute. Thirty patients underwent the procedure under intravenous general anesthesia with perianal anesthetics infiltration (Group 1) and thirty four patients under heavy sedation (intramuscular injections of meperidine and midazolam) with perianal anesthetics infiltration (Group 2). Both groups were compared in the areas of demographics, surgical features, pain score, complications, recurrence, and patient satisfaction. Results. There were no significant difference between group 1 and group 2 in patient age (mean age 41 vs. 43 years, p = 0.593), gender (male vs. female was 13:17 vs. 19:15, p = 0.316), ASA grade (27 ASA I and 3 ASA II in group 1; 29 ASA I and 5 ASA II in group 2, p = 0.713), hemoglobin level (12.2 vs. 12.4 g/dl, p = 0.711), bleeding time value (4.1 vs. 3.9 min, p = 0.658) and duration of follow-up (4.3 vs. 4.4 months, p = 0.703). There was no incident of anesthetic associated complications occurred in both groups. All patients tolerated the hemorrhoidectomy in the prone jackknife position. Therewere also no statistic significance between both groups in procedure time (36.3 vs. 33.2 min, p = 0.223), early or late complications (p = 0.940), duration of hospital stay (2.9 vs. 2.7 days, p = 0.489), pain score on the morning of the first postoperative day (pain score of 5.1 vs. 5.3, p = 0.524) and the postoperative consumption of analgesics use (meperidine use of 105mg and 110mg per person in group 1 and group 2 respectively, p = 0.585). However, the mean time spent in the operating room was significant longer in Group 1 than in Group 2 (61.5 vs. 41.7 min, p < 0.05). Pain score during the operation was significant higher in Group 2 (pain score of 0.5 vs. 6.2, p < 0.05). Patient satisfaction level was superior in Group 1 (satisfied or very satisfied: 25/30 in group 1 vs. 14/34 in group 2, p = 0.007). Conclusion. Both anestheticmethods for hemorrhoidectomy were safe and effectivewithout significant difference in postoperative complications and recurrence. However, patients with intravenous general anesthesia needed more operating room time than those with heavy sedation, but it bears with a significantly lower pain score during the operation and a better satisfaction level.

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