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

Tarik Sammour, Ahmed W H Barazanchi, Andrew G. Hill, Francis Bonnet, Barrie Fischer, Girish Joshi, Henrik Kehlet, Philipp Lirk, Narinder Rawal, Stephan Schug, Marc Van de Velde, Marcel Vercauteren, The PROSPECT Working Group Collaborators

    Research output: Contribution to journalReview articlepeer-review

    69 Citations (Scopus)


    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
    Pages (from-to)603-614
    Number of pages12
    JournalWorld Journal of Surgery
    Issue number2
    Publication statusPublished - 1 Feb 2017


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