Evaluating Intradermal Methylene Blue Combined with Ropivacaine for Improving Recovery After Hemorrhoidectomy Surgery

What this Trial Is About

Researchers are studying the effect of intradermal methylene blue combined with ropivacaine injection on the quality of recovery after hemorrhoidectomy, a surgical procedure for patients with symptomatic third- and fourth-degree hemorrhoids. This study focuses on how methylene blue, known for its pain-relief properties through temporary nerve disruption, affects recovery quality compared to intravenous ketorolac, a commonly used pain medication. The investigation uses the Quality of Recovery-15 QOR-15 questionnaire to objectively measure recovery across physical and emotional dimensions. Participants will receive standardized spinal anesthesia with ropivacaine, followed by hemorrhoidectomy performed by experienced colorectal surgeons. Postoperative pain management varies by group the methylene blue group receives a subcutaneous injection of methylene blue combined with ropivacaine around the perianal incision, while the comparison group receives intravenous ketorolac at the start of surgery. Additional ketorolac doses may be given after surgery if needed, with dosing limits in place. The study includes a 6-month follow-up to monitor complications and recovery. Participants will complete the QOR-15 questionnaire the day before surgery and on postoperative days 1 and 2, with the day 1 score as the primary outcome. Other measures include pain scores at several postoperative time points, total hospital costs, analgesic use, and complications such as urinary retention, fecal incontinence, itching, bleeding, infection, and wound healing problems. Data collection involves clinical information, telephone interviews, and the Wexner score for fecal incontinence, providing a thorough evaluation of recovery and safety over six months.

The Impact of Methylene Blue on the Quality of Recovery in Patients Undergoing Hemorrhoidectomy