Introduction: Post-surgical urinary retention requiring a catheter has a mean incidence of 15% (1% to 52%) in the post-operative period after anal surgery. The primary objective of this study was to assess the efficacy of topical rectal Diclofenac in reducing post-surgical haemorrhoidectomy urinary retention. Its impact on the reduced need for post-surgery analgesia has also been assessed as a secondary objective.
Patients and method: The 157 patients intervened for symptomatic haemorrhoids were randomised into two groups: Group with 100 mg diclofenac anal suppository after surgery; and Control group without diclofenac. Haemorrhoidectomy was performed with diathermy, without pedicle ligatures and with hyperbaric spinal anaesthesia. No anal dressings were used and the use of drips was restricted during the post-operative period. Metamizole and diclofenac were used as post-surgical intravenous analgesia in all patients. Meperidine was chosen as rescue analgesia. The descriptive variables evaluated in the patient series were: age, sex, grade and number of haemorrhoid groups, and post-surgical complications. The response variables were: need or not for a urethral catheter, post-surgical pain (Visual Analogue Scale) VAS and rescue analgesia requirements.
Results: The 86 males (54.6%) and 71 females (45.4%), with a mean age of 54 years (26-82 years) were randomised into 2 groups: 73 (46.5%) in the diclofenac group and 84 (53.5% in the control group. Of the haemorrhoidectomies performed, 95 were open and 63 were closed. There were no differences as regards the distribution by, age, sex, haemorrhoid grade or in the number of haemorrhoid groups extirpated. Only 1 (1.3%) patient in the diclofenac group and 8 (9.5%) in the control group (p = 0.028) had urine retention. Rescue analgesia was required by 9 (12.3%) patients in the study group compared to 20 (33.3%) in the control group (p = 0.002). The assessment of the magnitude of therapeutic effect of diclofenac gave an RRR of 85.6% (95% CI, 12.3-98.2), RAR, 8.2% (95% CI, 1.3-15) and an NNT of 13 (95% CI, 7-77).
Conclusions: The placing of a 100 mg diclofenac suppository at the end of a haemorrhoidectomy reduces urinary retention and rescue analgesia requirements.