Evidence-based management of pain after haemorrhoidectomy surgery.
BACKGROUND
Haemorrhoidectomy is associated with intense postoperative pain, but optimal evidence-based pain therapy has not been described. The aim of this systematic review was to evaluate the available literature on the management of pain after haemorrhoidal surgery.


METHODS
Randomized studies published in the English language from 1966 to June 2006, assessing analgesic and anaesthetic interventions in adult haemorrhoidal surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases.


RESULTS
Of the 207 randomized studies identified, 106 met the inclusion criteria, with mixed methodological quality. Of these, 41 studies evaluating surgical and alternative interventions were excluded. Quantitative analyses were not performed, as there were limited numbers of trials with a sufficiently homogeneous design.


CONCLUSIONS
Local anaesthetic infiltration, either as a sole technique or as an adjunct to general or regional anaesthesia, and combinations of analgesics (non-steroidal anti-inflammatory drugs, paracetamol and opiates) are recommended. If appropriate, a stapled operation may be preferable.
Joshi
G P
GP
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas 75390-9068, USA. girish.joshi@utsouthwestern.edu
Neugebauer
E A M
EA
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D000765:Anesthesia, Conduction / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000627:therapeutic use; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D010149:Postoperative Pain / Q000517:prevention & control*; D013528:Surgical Staplers; D017792:Surgical Stapling
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids