背景:这项非随机研究旨在比较两种药物治疗的疗效,“全天候”镇痛治疗(ACAT)和“按需”镇痛治疗(ODAT),用于治疗痔疮切除术后的疼痛。材料和方法:研究,从2016年7月至2020年12月进行,包括5335例痔疮切除术患者。参与者分为ACAT(3767)和ODAT(1568)组。该研究在clinicaltrials.gov(NCT04953182)注册。结果:患者的平均年龄为47.47岁,男性占59.98%。术后,14.13%报告剧烈疼痛,36.49%中度,34.28%轻度,15.09%没有疼痛。ACAT组的最大疼痛为3.04(VAS),ODAT4.95(p;平均疼痛为0.79(ACAT)和1.45(ODAT)。出院疼痛为0.42(ACAT)和0.63(ODAT)VAS。ACAT组一致地报告在所有测量的情况下疼痛水平较低。较高的BMI和较年轻的年龄是疼痛的危险因素(分别为p=.049,p.001)。ACAT给药导致阿片类药物使用量减少,哌替啶下降了68.38%,吗啡减少43.57%,曲马多减少46.82%,羟考酮减少38.74%,可待因减少53.40%。此外,ACAT组非阿片类镇痛药的使用明显较低,与ODAT组相比减少16%至59%。结论:痔疮切除术可引起中度术后疼痛,只有14%的人经历剧烈的疼痛。固定的时间表多模式疼痛方案,无论程序和麻醉类型,减少从中度到轻度痔疮切除术后的疼痛。这种方法还降低了阿片类和非阿片类镇痛药的需求。较高的BMI和较年轻的年龄被认为是术后疼痛升高的危险因素。
Background: This non-randomized study aimed to compare the efficacy of two pharmacological treatments, \"around-the-clock\" analgesic treatment (ACAT) and \"on-demand\" analgesic treatment (ODAT), for managing postoperative pain following hemorrhoidectomy. Material and Methods: The study, conducted from July 2016 to December 2020, included 5335 hemorrhoidectomy patients. Participants were divided into ACAT (3767) and ODAT (1568) groups. The study was registered at clinicaltrials.gov (NCT04953182). Results: Patients had a mean age of 47.47 years, with 59.98% males. Postoperatively, 14.13% reported severe pain, 36.49% moderate, 34.28% mild, and 15.09% no pain. ACAT group\'s maximum pain was 3.04 (VAS), ODAT 4.95 (p; average pain was 0.79 (ACAT) and 1.45 (ODAT). Discharge pain was 0.42 (ACAT) and 0.63 (ODAT) VAS. The ACAT group consistently reported lower levels of pain across all measured instances. Higher BMI and younger age were pain risk factors (p=.049, p .001 respectively). ACAT administration resulted in reduced opioid usage, with meperidine showing a 68.38% decrease, morphine 43.57% less, tramadol 46.82% less, oxycodone reduced by 38.74%, and codeine by 53.40%. Additionally, the use of non-opioid analgesics was notably lower in the ACAT group, ranging from 16% to 59% less compared to the ODAT group. Conclusion: Hemorrhoidectomy induces moderate postoperative pain, with only 14% experiencing severe pain. A fixed schedule multimodal pain regimen, regardless of procedure and anesthesia type, reduces pain from moderate to mild post-hemorrhoidectomy. This approach also decreases opioid and non-opioid analgesic requirements. Higher BMI and younger age are identified as risk factors for elevated postoperative pain.