Evidence-Based Management of Pain After Excisional Haemorrhoidectomy Surgery: A PROSPECT Review Update

Background The aim of this systematic review was to update previous PROSPECT ( http://www.postoppain.org ) review recommendations for the management of pain after excisional haemorrhoidectomy. Methods Randomized studies and reviews published in the English language from July 2006 (end date of last r...

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Bibliographic Details
Published in:World journal of surgery 2017-02, Vol.41 (2), p.603-614
Main Authors: Sammour, Tarik, Barazanchi, Ahmed W. H., Hill, Andrew G.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Analgesics - therapeutic use
Anesthetics, Local
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Cardiac Surgery
Diosmin
Evidence-Based Medicine
General Surgery
Hemorrhoidectomy - adverse effects
Hemorrhoidectomy - methods
Humans
Lateral Internal Sphincterotomy
Lidocaine
Liposomal Bupivacaine
Medicine
Medicine & Public Health
Nerve Block
Open Haemorrhoidectomy
Pain, Postoperative - drug therapy
Pudendal Nerve
Randomized Controlled Trials as Topic
Review Literature as Topic
Scientific Review
Surgery
Thoracic Surgery
Trimebutine
Vascular Surgery
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Summary:Background The aim of this systematic review was to update previous PROSPECT ( http://www.postoppain.org ) review recommendations for the management of pain after excisional haemorrhoidectomy. Methods Randomized studies and reviews published in the English language from July 2006 (end date of last review) to March 2016, assessing analgesic, anaesthetic, and operative interventions pertaining to excisional haemorrhoidectomy in adults, and reporting pain scores, were retrieved from the EMBASE and MEDLINE databases. Results An additional 464 studies were identified of which 74 met the inclusion criteria. There were 48 randomized controlled trials and 26 reviews. Quantitative analyses were not performed, as there were limited numbers of trials with a sufficiently homogeneous design. Conclusion Pudendal nerve block, with or without general anaesthesia, is recommended for all patients undergoing haemorrhoidal surgery. Either closed haemorrhoidectomy, or open haemorrhoidectomy with electrocoagulation of the pedicle is recommended as the primary procedure. Combinations of analgesics (paracetamol, non-steroidal anti-inflammatory drugs, and opioids), topical lignocaine and glyceryl trinitrate, laxatives, and oral metronidazole are recommended post-operatively. The recommendations are largely based on single intervention, not multimodal intervention, studies.
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-016-3737-1