Analgesic effect of local anaesthetic in haemorrhoid banding: systematic review and meta-analysis

• Published in: International journal of colorectal disease Vol. 39; no. 1; p. 34
• Main Authors: Watson, Eleanor G. R., Ong, Hwa Ian, Shearer, Nicholas J. W., Smart, Philip J., Burgess, Adele N., Proud, David M., Mohan, Helen M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 04-03-2024
• Subjects: Anesthesia, Local; Anesthetics, Local; Gastroenterology; Hemorrhoids - surgery; Hepatology; Humans; Internal Medicine; Medicine; Medicine & Public Health; Pain; Pain, Procedural; Proctology; Review; Surgery; Surgeons; Haemorrhoids; Anaesthesia, Local; Pain management
• ISSN: 1432-1262; 0179-1958; 1432-1262
• DOI: 10.1007/s00384-024-04609-8

Purpose
Rubber band ligation of haemorrhoids can be,painful and there is no consensus regarding the optimal analgesic strategy. This study aims to determine whether there is a difference in post-procedural pain in adults undergoing haemorrhoid banding who have received local anaesthetic, a pudendal nerve block or no regional or local analgesia.
Methods
MEDLINE, Embase, Google Scholar and clinical trial registries were searched for randomised trials of local anaesthetic or pudendal nerve block use in banding. Primary outcomes were patient-reported pain scores. The quality of the evidence was assessed using the GRADE approach.
Results
Seven studies were included in the final review. No articles were identified that studied pudendal nerve blocks. The difference in numerical pain scores between treatment groups favoured the local anaesthetic group at all timepoints. The mean difference in scores on a 10-point scale was at 1 h,—1.43 (95% CI—2.30 to—0.56,
p
 < 0.01,
n
 = 342 (175 in treatment group)); 6 h,—0.52 (95% CI—1.04 to 0.01,
p
 = 0.05,
n
 = 250 (130 in treatment group)); and 24 h,—0.31 (95% CI—0.82 to 0.19,
p
 = 0.86,
n
 = 247 (127 in treatment group)). Of reported safety outcomes, vasovagal symptoms proceeded to meta-analysis, with a risk ratio of 1.01 (95% CI 0.64–1.60). The quality of the evidence was rated down to ‘low’ due to inconsistency and imprecision.
Conclusion
This review supports the use of LA for reducing early post-procedural pain following haemorrhoid banding. The evidence was limited by small sample sizes and substantial heterogeneity across studies.
Registration
PROSPERO (ID CRD42022322234)