Pain Trajectory after Short-Stay Anorectal Surgery: A Prospective Observational Study

Abstract OBJECTIVE: The dense distribution of perianal nerves, having to defecate, and underappreciated analgesia make the postoperative pain of anorectal surgery significantly serious. However, the evolution of pain after anorectal surgery has not been well characterized. The main objective is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery.The main objective is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery. Methods: The study included 217 patients who underwent anorectal surgery for hemorrhoids and anorectal fistula. The VAS pain scale was used to record the pain across postoperative days 1 through 10. The primary analysis used group-based trajectory modeling to estimate the trajectory of postoperative pain. Secondary analysis examined the relationships between sociodemographic, types of surgery, preoperative anxiety score and pain behavior score, and postoperative analgesics and pain trajectories. RESULTS: Three distinct postoperative pain trajectories were determined. Many patients (57.0%) belonged to the high-low group, followed by the low group (23.3%) and the low-moderate-low group (19.7%). Moreover, 62.7% of patients reported pain stable and sustained moderate-to-high over the first 7 days after surgery, while 97% had decreased to mild pain by the 10th day. Hemorrhoidectomy (odds ratio, 0.15), higher anxiety (odds ratio, 3.26), and higher preoperative pain behavior score (odds ratio, 3.15), were associated with an increased likelihood of being in the high pain trajectory in multivariate analysis. The pain trajectory group was related to postoperative analgesic use (P<0.001), with the high-low group needing more nonsteroidal analgesics. CONCLUSIONS: There are three obvious pain trajectories after anorectal surgery for hemorrhoids and anal fistula, including an unreported low-moderate-low type. More than 60% of patients maintained moderate and severe pain within 7 days after the operation. These postoperative pain trajectories were predominantly defined by surgery factors and patient factors.