TY - JOUR
T1 - Evidence-Based Management of Pain After Excisional Haemorrhoidectomy Surgery
T2 - A PROSPECT Review Update
AU - Sammour, Tarik
AU - Barazanchi, Ahmed W H
AU - Hill, Andrew G
AU - PROSPECT group (Collaborators)
A2 - Kehlet, Henrik
PY - 2017/2
Y1 - 2017/2
N2 - 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.
AB - 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.
KW - Analgesics/therapeutic use
KW - Anesthetics, Local
KW - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
KW - Evidence-Based Medicine
KW - Hemorrhoidectomy/adverse effects
KW - Humans
KW - Lidocaine
KW - Nerve Block
KW - Pain, Postoperative/drug therapy
KW - Pudendal Nerve
KW - Randomized Controlled Trials as Topic
KW - Review Literature as Topic
U2 - 10.1007/s00268-016-3737-1
DO - 10.1007/s00268-016-3737-1
M3 - Review
C2 - 27766395
SN - 0364-2313
VL - 41
SP - 603
EP - 614
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 2
ER -