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

on behalf of the PROSPECT group (Collaborators)

Research output: Contribution to journalArticle

13 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalWorld Journal of Surgery
DOIs
StateAccepted/In press - Oct 20 2016

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Hemorrhoidectomy
Pain Management
Analgesics
Pudendal Nerve
Laxatives
Electrocoagulation
Nerve Block
Metronidazole
Nitroglycerin
Acetaminophen
Lidocaine
MEDLINE
General Anesthesia
Opioid Analgesics
Anesthetics
Anti-Inflammatory Agents
Language
Randomized Controlled Trials
Databases
Pain

ASJC Scopus subject areas

  • Surgery

Cite this

Evidence-Based Management of Pain After Excisional Haemorrhoidectomy Surgery : A PROSPECT Review Update. / on behalf of the PROSPECT group (Collaborators).

In: World Journal of Surgery, 20.10.2016, p. 1-12.

Research output: Contribution to journalArticle

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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.",
author = "{on behalf of the PROSPECT group (Collaborators)} and Tarik Sammour and Barazanchi, {Ahmed W H} and Hill, {Andrew G.} and Francis Bonnet and Barrie Fischer and Girish Joshi and Henrik Kehlet and Philipp Lirk and Narinder Rawal and Stephan Schug and {van de Velde}, Marc and Marcel Vercauteren",
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