Intrathecal versus epidural morphine for analgesia following excisional haemorrhoidectomy: a comparative analysis

Background: Postoperative pain remains a significant concern in open excisional haemorrhoidectomy, especially for patients with third- and fourth-degree haemorrhoids, which are often associated with severe pain, bleeding, and other debilitating symptoms. Poorly managed postoperative pain adversely affects recovery. Aim: To compare postoperative pain scores using the Visual Analogue Scale (VAS) after the administration of intrathecal morphine versus epidural morphine, both combined with intravenous paracetamol and rectal diclofenac suppository, for pain management following open excisional haemorrhoidectomy. Methods: A prospective, randomized controlled study was conducted at the University of Port Harcourt Teaching Hospital (UPTH) over 4years on adult patients with third- or fourth-degree haemorrhoids, for open haemorrhoidectomy. The differences between the two groups were measured using Student t-test and Chi-squared test and were considered statistically significant if p< 0.05. Results: A total of sixty-six patients completed the study: 30 patients in Group A (intrathecal morphine) and 36 in Group B (epidural morphine). The mean time to a VAS score ≥ 5 cm was significantly shorter in Group A (8.3 ± 4 hours) compared to Group B (24 ± 6.8 hours), with a p-value of 0.0001. Patient satisfaction was reported by 78% of patients in Group A and by all patients (100%) in Group B (p < 0.01). Conclusion: Epidural morphine, in combination with intravenous paracetamol and rectal suppository, provided superior postoperative pain relief following haemorrhoidectomy and facilitated earlier ambulation compared to intrathecal morphine.