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For hemorrhoidectomy, it is the standard of treatment in many health care systems. Perioperative management including adequate pain control is of paramount importance to ensure successful ambulatory surgery. This study investigates the role and effect of morphine compared to short-acting opiates applied before, during, or after proctological interventions and with focus on hemorrhoidectomy. A retrospective analysis of a prospective database was conducted comparing two populations. The control cohort received morphine (Yes-M\u00f4) intra- and postoperatively, while the intervention group did not receive morphine (No-M\u00f4) between January 2018 and January 2020. Both cohorts were balanced by propensity score matching. The outcomes were postoperative pain measured by numeric ratings scale (NRS) one hour postoperatively, pain 24\u00a0h postoperatively, success rate of outpatient management, and complication rate including postoperative nausea and vomiting as well as urinary retention. The intervention population comprised 54 patients and the control group contained 79 patients. One hour after surgery, patients in No-M\u00f4 reported lower NRS (1.44\u2009\u00b1\u20091.41) compared to Yes-M\u00f4 (2.48\u2009\u00b1\u20092.30) (<jats:italic>p<\/jats:italic>\u2009=\u20090.029). However, there was no difference in NRS 24 h postoperatively (No-M\u00f4: 1.61\u2009\u00b1\u20091.41 vs Yes-M\u00f4: 1.63\u2009\u00b1\u20091.72; <jats:italic>p<\/jats:italic>\u2009=\u20090.738). 100% of No-M\u00f4 was managed as outpatients while only 50% of Yes-M\u00f4 was dismissed on the day of the operation (<jats:italic>p<\/jats:italic>\u2009=\u2009&lt;\u20090.001). There was no difference in postoperative complications (including postoperative nausea and vomiting (PONV) and urinary retention) between the two groups (PONV No-M\u00f4 7.4% vs Yes-M\u00f4 5.6%, <jats:italic>p<\/jats:italic>\u2009=\u20091.0 and urinary retention No-M\u00f4 3.7% vs Yes-M\u00f4 7.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.679). No-M\u00f4 received an oral morphine equivalent of 227.25\u2009\u00b1\u2009140.35\u00a0mg intraoperatively and 11.02\u2009\u00b1\u200918.02\u00a0mg postoperatively. Yes-M\u00f4 received 263.17\u2009\u00b1\u2009153.60\u00a0mg intraoperatively and 15.97\u2009\u00b1\u200914.17\u00a0mg postoperatively. The difference in received morphine equivalent between the groups was not significant after matching for the intraoperative (<jats:italic>p<\/jats:italic>\u2009=\u20090.212) and postoperative (<jats:italic>p<\/jats:italic>\u2009=\u20090.119) received equivalent. Omission of perioperative morphine is a viable but yet not understood method for reducing postoperative pain. Omission of morphine leads to a lower use of total morphine equivalent to attain satisfactory analgesia. The reduction of the overall opiate load and using opiates with a very short half-life potentially leads to a reduction of side effects like sedation. This in turn promotes discharge of the patient on the day of surgery. Omission of morphine is safe and does not increase postoperative complications.<\/jats:p>","DOI":"10.1007\/s13304-023-01640-2","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T10:02:48Z","timestamp":1693908168000},"page":"155-161","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Omission of perioperative morphine reduces postoperative pain in proctological interventions: a single-center analysis"],"prefix":"10.1007","volume":"76","author":[{"given":"Fabian","family":"Haak","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Nocera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorena","family":"Merlo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belma","family":"Dursunoglu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvio","family":"D\u00e4ster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiorenzo V.","family":"Angehrn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4111-2909","authenticated-orcid":false,"given":"Daniel C.","family":"Steinemann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,9,5]]},"reference":[{"issue":"Suppl","key":"1640_CR1","doi-asserted-by":"publisher","first-page":"S41","DOI":"10.1016\/j.jviscsurg.2019.04.005","volume":"156","author":"A Theissen","year":"2019","unstructured":"Theissen A, Slim K, Deleuze A, Beaussier M (2019) Risk management in outpatient surgery. 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The study was approved by the Ethical Committee of Northwestern Switzerland.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals, and Informed consent"}},{"value":"The author(s) declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}