Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Abstract

Background and Objectives: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain. Materials and Methods: The databases of Ovid MEDLINE, PubMed and EMBASE were systematically searched for randomized controlled trails (published in English language with full-text from 1981 to 30 September 2021) to include comparative studies examining post-hemorrhoidectomy pain as their primary outcomes between an intervention and another intervention (or a sham or placebo). Results:Some 157 studies were included in this review with additional information from 15 meta-analyses. Fundamentally, strategies to reduce post-hemorrhoidectomy pain were categorized into four groups: anesthetic methods, surgical techniques, intraoperative adjuncts, and postoperative interventions. In brief, local anesthesia-alone or combined with intravenous sedation was the most effective anesthetic method for excisional hemorrhoidectomy. Regarding surgical techniques, closed (Ferguson) hemorrhoidectomy performed with a vascular sealing device or an ultrasonic scalpel was recommended. Lateral internal anal sphincterotomy may be performed as a surgical adjunct to reduce post-hemorrhoidectomy pain, although it increased risks of anal incontinence. Chemical sphincterotomy (botulinum toxin, topical calcium channel blockers, and topical glyceryl trinitrate) was also efficacious in reducing postoperative pain. So were other topical agents such as anesthetic cream, 10% metronidazole ointment, and 10% sucralfate ointment. Postoperative administration of oral metronidazole, flavonoids, and laxatives was associated with a significant reduction in post-hemorrhoidectomy pain. Conclusions: This systematic review comprehensively covers evidence-based strategies to reduce pain after excisional hemorrhoidectomy. Areas for future research on this topic are also addressed at the end of this article.

Effectiveness of Standard Local Anesthetic Bupivacaine and Liposomal Bupivacaine for Postoperative Pain Control in Patients Undergoing Truncal Incisions

“…Adequate postoperative pain management improves the functional recovery and healing period but also contributes to reduction in postsurgical complication risk and faster patient mobilization, thereby reducing the hospital length of stay and health care costs. 5,6 Short duration of action is a common drawback of most perioperative pain management regimens, including local anesthetic infiltrations lasting for less than 8 hours. 6,7 An injectable extended-release bupivacaine formulation lasting up to 72 hours has gained popularity.…”

“…5,6 Short duration of action is a common drawback of most perioperative pain management regimens, including local anesthetic infiltrations lasting for less than 8 hours. 6,7 An injectable extended-release bupivacaine formulation lasting up to 72 hours has gained popularity. Several studies [8][9][10][11][12] on various surgical procedures, including hemorrhoidectomy, bunionectomy, mastectomy, and orthopedic surgery, reported a reduction in postoperative pain (up to 30%) and opioid use following intraoperative use of liposomal bupivacaine compared with placebo and active control.…”

Picking Up the Threads: Long-Term Outcomes of the Sutured Haemorrhoidopexy: A Retrospective Single-Centre Cohort Study

“…Besides the higher overall complication rate of haemorrhoidectomy, up to 65% of patients reported moderate to severe pain following this technique, resulting in increased postoperative analgesic use [33][34][35]. In our study, 53 patients (36.6%) reported postoperative anal pain and the majority of these patients required analgesics.…”

Analgesics around the clock is better than the on-demand modality for pain treatment after hemorrhoid surgery

“…Untreated acute pain leads to reduced patient satisfaction and increased morbidity and mortality, which detrimentally in uence patients' quality of life and daily activities, disturb their sleep and worsen their affective mood [19]. Although new surgical techniques and treatments, postoperative pain and discomfort remain major challenges with postoperative pain and disease recurrence continuing to complicate the treatment of hemorrhoids [20,21]. In our cohort of patients, the maximum peak of pain reported was moderate, and the average pain reported has been mild, however, only 12% of patients reported severe pain at some point in international.…”