Our Summary

This study carried out in China sought to compare the effectiveness and safety of a new pain reliever drug, HR18034, with an existing one, ropivacaine, for patients who had undergone a hemorrhoid surgery. The new drug is basically the existing drug ropivacaine encased in a special type of fat cell (liposome) structure, with a small amount of free ropivacaine in the mix. This was a large-scale test done across 19 medical centers involving 85 patients, who received different doses of the new drug or the old one.

Their main way of measuring effectiveness was by seeing how much pain (measured by a scale called the NRS score) the patients experienced at various times after the surgery. They also looked at how many patients didn’t feel any pain, how many didn’t need any additional pain relief, and how much extra morphine was used for those who did need it. They also monitored any side effects and measured the levels of the drug in the blood to understand how it was being processed by the body.

The results showed that the highest dose of the new drug (380 mg) was more effective at reducing pain than the existing drug, 24, 48, and 72 hours after the surgery. However, this was not the case for the lower doses of the new drug. There was no difference between the new and old drug in terms of the amount of extra morphine needed.

In conclusion, the highest dose of the new drug seemed to work better for pain relief after hemorrhoid surgery and was just as safe as the existing drug. The researchers suggest that 380 mg could be the minimum effective dose for this new drug.

FAQs

  1. What is HR18034 and how does it compare to ropivacaine in terms of postoperative analgesia after hemorrhoidectomy?
  2. What were the main findings of the trial investigating the efficacy and safety of HR18034?
  3. What was determined as the minimum effective dose of HR18034 for postoperative analgesia after hemorrhoidectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hemorrhoidectomy is to follow post-operative care instructions carefully, including taking prescribed pain medications as directed, keeping the surgical area clean and dry, and avoiding straining during bowel movements to prevent complications.

Suitable For

Hemorrhoidectomy is typically recommended for patients with severe or persistent hemorrhoids that do not respond to conservative treatments such as dietary modifications, topical medications, and lifestyle changes. Patients who may benefit from hemorrhoidectomy include those with:

  1. Large external hemorrhoids that are causing significant pain, discomfort, or bleeding
  2. Internal hemorrhoids that have prolapsed or are causing symptoms such as bleeding, itching, or pain
  3. Recurrent hemorrhoids that do not improve with other treatments
  4. Patients with thrombosed hemorrhoids (hemorrhoids with a blood clot) that are causing severe pain and swelling

It is important for patients to discuss their symptoms and treatment options with a healthcare provider to determine if hemorrhoidectomy is the most appropriate course of action for their individual situation.

Timeline

  • Before hemorrhoidectomy: The patient may experience symptoms such as pain, itching, swelling, and bleeding from hemorrhoids. They may have tried conservative treatments such as sitz baths, topical creams, and dietary changes without success.
  • Day of hemorrhoidectomy: The patient undergoes the surgical procedure to remove the hemorrhoids. Local or general anesthesia is administered depending on the type of surgery.
  • Immediately after hemorrhoidectomy: The patient may experience pain, discomfort, and swelling in the anal area. They are given pain medications and instructions on postoperative care.
  • Postoperative period: The patient continues to experience pain and discomfort as the surgical site heals. They may need to take pain medications, use stool softeners, and avoid straining during bowel movements.
  • Weeks to months after hemorrhoidectomy: The patient’s symptoms gradually improve as the surgical site heals completely. They may have follow-up appointments with their healthcare provider to monitor their recovery and address any concerns.

What to Ask Your Doctor

  1. What is the success rate of a hemorrhoidectomy using HR18034 compared to traditional methods?
  2. What are the potential side effects or risks of using HR18034 for postoperative analgesia after hemorrhoidectomy?
  3. How long is the recovery time expected to be with HR18034 compared to other pain management options?
  4. Are there any specific precautions or instructions I should follow after receiving HR18034 for pain relief?
  5. How does HR18034 work differently than traditional local anesthetics for postoperative pain management?
  6. Will I need any additional pain medication or treatments in conjunction with HR18034 after my hemorrhoidectomy?
  7. How long can I expect the effects of HR18034 to last after the procedure?
  8. Are there any specific factors that may make me ineligible for treatment with HR18034 for postoperative pain management after hemorrhoidectomy?
  9. Is HR18034 covered by insurance or will I need to pay out of pocket for this treatment option?
  10. Can you provide me with more information or resources about HR18034 and its use in postoperative analgesia for hemorrhoidectomy?

Reference

Authors: Li Q, Xu S, Ou Y, Zhou L, Huang F, Jiang W, Xie H, Zou X, Gao J, Jin S, Zhou H, Huang Y, Pan Z, Liu J, Wang G, Li X, Sun C, Zhao L, Li L, Liu Q, Duan K, Wang S. Journal: J Clin Anesth. 2024 Oct;97:111524. doi: 10.1016/j.jclinane.2024.111524. Epub 2024 Jun 27. PMID: 38941870