Haemorrhoidectomy under local anaesthesia versus spinal anaesthesia: a systematic review and meta-analysis

Mohamedahmed, Ali Yasen Y.; Stonelake, Stephen; Mohammed, Salma Saeed S.; Zaman, Shafquat; Ahmed, Hatim; Albarade, Magde; Hajibandeh, Shahin

doi:10.1007/s00384-020-03733-5

Cited by 9 publications

(10 citation statements)

References 33 publications

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“…Preferred anesthetic techniques could vary among patients, surgeons, hospitals, and countries. Effects of anesthetic techniques on post-hemorrhoidectomy pain have been extensively examined in at least 18 RCTs with a total number of 1465 patients [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. A recent systematic review and meta-analysis of seven RCTs comprising 440 patients undergoing excisional hemorrhoidectomy (222 patients with local anesthesia plus intravenous sedation, and 218 patients with spinal anesthesia) has found that local anesthesia combined with intravenous sedation had a significantly lower pain score at 6 h and 24 h after an operation–with mean difference of numerical pain rating scale −2.25 (95% CI −3.26 to −1.24) and −0.87 (95% CI −1.33 to −0.40), respectively [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Lohsiriwat

Jitmungngan

2022

Medicina

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Background and Objectives: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain. Materials and Methods: The databases of Ovid MEDLINE, PubMed and EMBASE were systematically searched for randomized controlled trails (published in English language with full-text from 1981 to 30 September 2021) to include comparative studies examining post-hemorrhoidectomy pain as their primary outcomes between an intervention and another intervention (or a sham or placebo). Results:Some 157 studies were included in this review with additional information from 15 meta-analyses. Fundamentally, strategies to reduce post-hemorrhoidectomy pain were categorized into four groups: anesthetic methods, surgical techniques, intraoperative adjuncts, and postoperative interventions. In brief, local anesthesia-alone or combined with intravenous sedation was the most effective anesthetic method for excisional hemorrhoidectomy. Regarding surgical techniques, closed (Ferguson) hemorrhoidectomy performed with a vascular sealing device or an ultrasonic scalpel was recommended. Lateral internal anal sphincterotomy may be performed as a surgical adjunct to reduce post-hemorrhoidectomy pain, although it increased risks of anal incontinence. Chemical sphincterotomy (botulinum toxin, topical calcium channel blockers, and topical glyceryl trinitrate) was also efficacious in reducing postoperative pain. So were other topical agents such as anesthetic cream, 10% metronidazole ointment, and 10% sucralfate ointment. Postoperative administration of oral metronidazole, flavonoids, and laxatives was associated with a significant reduction in post-hemorrhoidectomy pain. Conclusions: This systematic review comprehensively covers evidence-based strategies to reduce pain after excisional hemorrhoidectomy. Areas for future research on this topic are also addressed at the end of this article.

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Section: Resultsmentioning

confidence: 99%

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Lohsiriwat

Jitmungngan

2022

Medicina

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“…Taken together, PNB is a common efficient analgesic strategy used after hemorrhoidectomy. In comparison with other recent studies, our perspective focuses on the three main aspects of PNB anesthesia in analgesia, alleviation of complications and reduction of side effects after hemorrhoid surgery (29,30). PNB has its unique advantages due to the special anatomical structure.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials

Li¹,

Hua²,

Qin³

et al. 2021

Ann Palliat Med

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Pudendal nerve block (PNB) is one of the common anesthesia methods, which has been widely applied in postoperative analgesia of hemorrhoids in recent years. To analyze the effectiveness and safety of PNB on postoperative analgesia of hemorrhoids, we conducted a systematic review of 7 randomized controlled trials (RCT) searched from PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), the China Network Knowledge Infrastructure (CNKI), the Wan Fang Database and Chinese Biomedicine (CBM), which were published before 7th September, 2020, and involved a total of 560 participants. We evaluated the function of PNB in improving outcomes of postoperative analgesia of hemorrhoids. Visual analogue scale (VAS) scores on postoperative 6, 12, 24, 48 h and the first time of defecation were enhanced by the application of PNB. The incidence of urinary retention, the need for analgesics [odds ratio (OR), 0.11; 95% CI, 0.04-0.37; P=0.0003] and the incidence of side effects (OR, 0.12; 95% CI, 0.04-0.39; P=0.004) in patients receiving PNB were lower than those of controls. In addition, there was no significant difference in the incidence of bleeding between groups. PNB could effectively relieve postoperative pain of hemorrhoids and reduce complications without increasing the incidence of side effects. Our results still need to be confirmed by high-quality, multi-center clinical studies.

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“…Several meta-analyses demonstrated that MMH performed under LA is associated with significantly lower postoperative pain within 24 h after surgery and a lower need for painkiller drugs compared to general or spinal anesthesia (13,14).…”

Section: Discussionmentioning

confidence: 99%

“…One possible disadvantage of LA is the fear of pain during the anesthetic injection, which can be minimized by the local application of anesthetic ointments before the injection (14).…”

Section: Discussionmentioning

confidence: 99%

“…Although, general or epidural anesthesia is the most commonly performed anesthetic techniques, local anesthesia (LA) is considered as a safe alternative with a significant reduction in complications (13)(14)(15). Ambulatory anorectal surgery is becoming a routine procedure for several proctologic diseases including fistula, abscess, condyloma, pilonidal disease, and hemorrhoids.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Effectiveness of Tailored Hemorrhoidectomy in Outpatients Setting

et al. 2021

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Introduction: Single or double prolapsed pile instead of full muco-hemorrhoidal prolapse is a common finding in patients with symptomatic III or IV degree hemorrhoids. For this selected group of patients, relief of symptoms could be achieved by managing the single/double prolapsed piles instead of performing traditional hemorrhoidectomy. The aim of this single-center study was to evaluate the safety and medium- and long-term effectiveness of an outpatient tailored Milligan-Morgan hemorrhoidectomy (MMH) performed under local anesthesia (LA).Material and methods: Clinical records of 202 patients submitted to outpatient tailored MMH, under LA and without anal dilation, treated between 2013 and 2020, were retrospectively reviewed using a prospectively maintained database and completed by a telephone interview or outpatient consultation. Postoperative pain score, the need for painkillers, postoperative complications and symptoms recurrence, return to working activities, and patient grading assessment scale were recorded.Results: Thirty-five (17%) out of 202 patients recruited were lost to the follow-up. One hundred and fifty-two and 15 patients underwent a single and double pile hemorrhoidectomy, respectively. With regard to postoperative outcomes, visual analogue scale (VAS) decreased from a median value of 4 [interquartile range (IQR) 2–6] on the day of surgery to 1 (IQR 0–4) on the 10th postoperative day (p < 0.001). Sixty-one patients (37%) needed oral painkillers during the 1st week after surgery. There was no mortality or major postoperative complication. Bleeding requiring hospital readmission was reported in seven (4%) patients, and one patient underwent emergency surgery with no need for blood transfusion. No postoperative urinary retention, anal incontinence, or stricture occurred in the series. During the median follow-up of 39 (IQR 12–60) months, 26 patients (16%) reported symptoms of recurrence but only six underwent traditional MMH. Recovery to normal activity occurred within a median period of 6 days (IQR 3–10) and the Clinical Patient Grading Assessment Scale (CPGAS) at 1 year after surgery was reported to be a “good deal better.”Conclusions: Tailored MMH performed under LA in an ambulatory setting can be considered a safe and effective technique with high compliance and satisfaction of patients.

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Haemorrhoidectomy under local anaesthesia versus spinal anaesthesia: a systematic review and meta-analysis

Cited by 9 publications

References 33 publications

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials

Safety and Effectiveness of Tailored Hemorrhoidectomy in Outpatients Setting

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