A RANDOMIZED CONTROLLED TRIAL BETWEEN LOCAL INJECTION OF METHYLENE BLUE VERSUS NORMAL SALINE FOR MANAGEMENT OF PAIN IN POST HEMORRHOIDECTOMY PATIENTS- A COMPARATIVE STUDY

Background: Hemorrhoids have been an ailment to mankind since time immemorial. Treatment of hemorrhoids has evolved since but the constant complaint of the patient with any mode of surgical treatment is the post operative pain. Different analgesics have been tried locally and systemically to relieve the pain. Methylene blue is a well known drug for treating methemoglobinemia and also a dye used for various surgical procedures. Methylene blue is also has analgesic property and is being used in this study to minimize the post operative pain after Milligan Morgan hemorrhoidectomy.

Aims And Objectives: To compare local injection of methylene blue versus normal saline in the post operative pain management along with length of hospital stay in patients undergoing conventional Milligan Morgan hemorrhoidectomy.

Methodology: 51 cases where randomized into 2 groups by systematic randomization 26 cases were allotted study group who received 4 ml 1% methylene blue and 16 ml 0.5% bupivacaine subcutaneously around the hemorrhoid on table before the procedure and 25 patients were allotted control group will receive 16 ml 0.5% bupivacaine and 4 ml saline without methylene blue similarly and regular Milligan Morgan hemorrhoidectomy is performed after. Each hemorrhoidal pile received 4ml of the titrated mixture. Post operatively pain is assessed by the visual analogue scale and the amount of analgesics required by the patient up to 2 weeks is calculated.

Results: The post operative pain assessed on POD-3 and POD-7 between the two groups was found to be significant with a p value of 0.0001 and 0.0002 respectively with significant. The mean length of hospital stay for study group was 2.269 days and in the control group was 3days with a significant p value of 0.0120. 1 patient in study group needed additional analgesics and 8 patients in control group needed additional analgesics. 2 patients in each of the study and control groups developed acute retention of urine out of the which 1 patient developed greenish discoloration of urine which resolved spontaneously. Conclusion:Methylene blue acts as a good analgesic which reduces the morbidity for the patient and hence the patient can resume daily activities faster.