Subcutaneous morphine pump for postoperative hemorrhoidectomy pain management.
OBJECTIVE
Many anorectal procedures are currently being performed on an outpatient basis, hemorrhoidectomy being the exception because of the need for parenteral narcotics postoperatively. We investigated the effectiveness of a subcutaneous morphine pump (SQMP) for outpatient posthemorrhoidectomy pain control.


METHODS
In Phase 1 of our study, 22 patients undergoing radical hemorrhoidectomy were started on an SQMP protocol postoperatively. Twenty-nine patients received conventional postoperative narcotic dosing. In Phase 2, 19 patients enrolled in an SQMP protocol underwent hemorrhoidectomy in an ambulatory setting. Length of hospitalization, catheterization rate, and pain control were evaluated.


RESULTS
In Phase 1, zero patients in the study group and two in the control group required additional hospitalization beyond 23 hours for pain control. The rates of catheterization were similar between the two groups. Pain control was considered satisfactory in 21 of 22 study patients. There was no correlation between pain level and morphine dose. Eighteen of 22 patients experienced minor side effects, necessitating pump removal in two patients. In Phase 2, 18 of 19 patients on the SQMP were discharged from the recovery room. Cost analysis shows the combination of outpatient hemorrhoidectomy and the SQMP to be cost-effective in comparison with an inpatient stay.


CONCLUSIONS
The SQMP enables hemorrhoidectomy to be done on an outpatient basis. It provides effective pain control, enjoys high patient acceptance, and is cost-effective.
Goldstein
E T
ET
Department of Colon & Rectal Surgery, Orlando Regional Medical Center, Florida.
Williamson
P R
PR
Larach
S W
SW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D003365:Costs and Cost Analysis; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010865:Pilot Projects; D014546:Urinary Catheterization; D014555:Urination Disorders / Q000209:etiology / Q000628:therapy
D009020:Morphine