title: Evidence-Based Management of Pain After Excisional Haemorrhoidectomy Surgery: A PROSPECT Review Update.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Tarik
authors.initials: T
authors.lastname: Sammour
authors.affiliation: Department of Surgery, Palmerston North Public Hospital, 50 Ruahine St, Roslyn, Palmerston North, 4442, New Zealand. ahmedwhbarazanchi@gmail.com.
authors.forename: Ahmed W H
authors.initials: AW
authors.lastname: Barazanchi
authors.affiliation: Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.|Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D061865:Hemorrhoidectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008012:Lidocaine; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D060525:Pudendal Nerve; D016032:Randomized Controlled Trials as Topic; D012196:Review Literature as Topic
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D008012:Lidocaine