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World Journal of Surgery

Erschienen in:

20.10.2016 | Scientific Review

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

verfasst von: Tarik Sammour, Ahmed W. H. Barazanchi, Andrew G. Hill, on behalf of the PROSPECT group (Collaborators)

Erschienen in: World Journal of Surgery | Ausgabe 2/2017

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Abstract

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.

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Titel: Evidence-Based Management of Pain After Excisional Haemorrhoidectomy Surgery: A PROSPECT Review Update
verfasst von: Tarik Sammour
Ahmed W. H. Barazanchi
Andrew G. Hill
on behalf of the PROSPECT group (Collaborators)
Publikationsdatum: 20.10.2016
Verlag: Springer International Publishing
Erschienen in: World Journal of Surgery / Ausgabe 2/2017
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3737-1

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