title: Predictors of early postoperative pain after stapled haemorrhoidopexy.
abstract: OBJECTIVE
  Moderate to severe pain after stapled haemorrhoidopexy (SH) is not uncommon. This study was designed to identify the predictors of postoperative pain after SH in a single centre.
  
  
  METHODS
  Seventy-six patients with Grade II to IV haemorrhoids who underwent SH were selected from a prospectively compiled database. Preoperative data, including patient characteristics, manometry results and surgical data, were documented. Pain was evaluated during the first 24 h after the operation. Its intensity was classified into three grades according to the visual analogue scale (VAS) score: mild (VAS ≤ 3), moderate (VAS >3 to <5) and severe (VAS ≥ 5). Analgesics were not routinely given but were administered if the patient had moderate or severe pain. Both univariate and multivariate analyses were used to determine the predictors of postoperative pain.
  
  
  RESULTS
  Moderate and severe pain was noted in 43 (58.9%) patients. No patient was readmitted due to persistent anal pain during the month following discharge. Postoperative pain was significantly associated with gender (P = 0.017), age (P = 0.014), first initial sensory volume (P = 0.023) and constipation (P = 0.005) in univariate analysis. Multivariate analysis identified male gender as an independent predictor of postoperative moderate to severe pain (P = 0.037, OR = 3.1, 95% CI 1.07-9.09). The initial sensory volume and preoperative coexisting constipation were negative predictors of postoperative moderate to severe pain after SH (P = 0.037, OR = 0.320, 95% CI 0.110-0.934, and P = 0.036, OR = 0.255, 95% CI 0.071-0.913, respectively).
  
  
  CONCLUSIONS
  Male gender and the initial sensory volume are predictors of postoperative pain after SH. Anal manometry is recommended before the SH procedure. An active analgesia protocol should be considered for male patients with a low initial sensory volume after SH.
authors.affiliation: Department of Colorectal Surgery, Second Artillery General Hospital, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhao
authors.forename: J-H
authors.initials: JH
authors.lastname: Ding
authors.forename: S-H
authors.initials: SH
authors.lastname: Yin
authors.forename: X-L
authors.initials: XL
authors.lastname: Hou
authors.forename: K
authors.initials: K
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013997:Time Factors; D055815:Young Adult
keywords: Haemorrhoids; anorectal manometry; constipation; postoperative pain; stapled haemorrhoidopexy