Effects of ketorolac versus pethidine on the management of postoperative acute pain and complications after hemorrhoidectomy

Introduction: Pain management is one of the most essential components of postoperative care. Nowadays, the common treatment methods for pain include the use of two large groups of analgesics, namely opioids and nonsteroidal anti-inflammatory drugs (NSAIDs). Therefore, the present study aimed to compare the effects of ketorolac (i.e., a non-inflammatory drug) and pethidine (i.e., a synthetic opioid pain medication) on pain and complications due to hemorrhoidectomy. Methods: This randomized controlled trial included ۹۰ patients with hemorrhoids who underwent hemorrhoidectomy at Imam Reza Hospital in Birjand, Iran, from May ۲۰۱۷ to ۲۰۱۸. The participants were assigned into two groups, namely the ketorolac group who received ketorolac therapy and the pethidine group who received pethidine. The severity of pain and complications were measured immediately, as well as at ۶, and ۱۲ hours after surgery in both study groups. The quantitative data were expressed as mean and percentage. Data analysis was performed using SPSS software (version ۲۲.۰) through Mann-Whitney, Friedman, and Chi-square tests. A p-value less than ۰.۰۵ was considered statistically significant. Results: According to the obtained results, out of ۹۰ patients with hemorrhoid, ۷۰.۳% were males. The mean age of the participants was ۴۸.۲۹±۸.۸ years, and there was no significant difference between the two study groups regarding age (۴۷.۲±۸.۷ years in the pethidine group, and ۴۹.۴±۹ years in the ketorolac group, P=۰.۱۹۶). In the ketorolac group, the mean pain scores were ۲.۳۳±۱.۳۶, ۲.۲۸±۱.۰۰, and ۱.۵۷±۰.۷۵, immediately, as well as at ۶, and ۱۲ hours after surgery, respectively. In addition, in the pethidine group, the mean pain scores were obtained at ۳.۱۵±۱.۶۱, ۲.۶۴±۱.۰۰, and ۱.۹۷±۰.۶۹, immediately as well as at ۶, and ۱۲ hours after surgery, respectively. Accordingly, the pain level was significantly lower in the ketorolac group, compared to that in the pethidine group (P<۰.۰۵). However, the pain level was higher at ۲۴ hours after surgery in the ketorolac group than that in the pethidine group; nevertheless, the difference was not statistically significant (P=۰.۹۹۶). Conclusions: The findings of the present study suggest more significant therapeutic effects of nonsteroidal NSAIDs, compared to opioid drugs on pain after hemorrhoidectomy.