In people with grade 3 and 4 hemorrhoids and scheduled to undergo hemorrhoidectomy, perianal infiltration of tramadol substantially minimized the severity of pain after surgery, prolonged the time from the end of anesthesia to the first analgesic request, decreased pain scores at the first defecation, and lowered analgesic intake, according to the findings of a recent double-blind clinical trial.

Maryam Hatami et al. undertook this study to investigate the impact of tramadol on postoperative pain in 90 people (age 18-75 years) with hemorrhoids and undergoing hemorrhoidectomy. Participants were randomized to receive perianal infiltration of either 0.25% bupivacaine (bupivacaine group), or tramadol (tramadol group) or normal saline (control group) prior to hemorrhoidectomy.

Pain intensity (assessed using visual analog scale [VAS]), duration of surgery, analgesic intakes, mean sedation score, pain at first defecation, nausea and vomiting, and first request time for additional analgesia were examined. Patients in the tramadol group experienced the least pain while patients in the control group experienced most pain within the initial 24 hours after surgery. Duration of surgery was found to be comparable in all the groups.

The means of sedation scores displayed considerable differences across the groups. The time to first analgesic request was longest in the tramadol arm and shortest in the control arm. The intakes of ketorolac and pethidine in the control group were more when compared to the other two groups. Compared to bupivacaine and control groups, the tramadol group exhibited a reduced pain score at the first defecation, as shown in Table 1:

In terms of postoperative nausea and vomiting, no complications were witnessed. Taking into account the significant efficacy of tramadol in minimizing post-hemorrhoidectomy pain and its minor adverse effects, this therapeutic agent is recommended to be an effective topical anesthetic for alleviating post-hemorrhoidectomy pain.