Watson Eleanor G R, Ong Hwa Ian, Shearer Nicholas J W, Smart Philip J, Burgess Adele N, Proud David M, Mohan Helen M
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
Department of Surgery, Austin Hospital, Melbourne, VIC, Australia.
Int J Colorectal Dis. 2024 Mar 4;39(1):34. doi: 10.1007/s00384-024-04609-8.
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.
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.
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.
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.
PROSPERO (ID CRD42022322234).
痔的橡皮圈套扎术可能会很痛，而且关于最佳镇痛策略尚无共识。本研究旨在确定接受局部麻醉、阴部神经阻滞或未接受区域或局部镇痛的成人痔套扎术后疼痛是否存在差异。
检索MEDLINE、Embase、谷歌学术和临床试验注册库，查找局部麻醉或阴部神经阻滞用于套扎术的随机试验。主要结局是患者报告的疼痛评分。采用GRADE方法评估证据质量。
最终综述纳入了7项研究。未找到研究阴部神经阻滞的文章。治疗组之间数字疼痛评分的差异在所有时间点都有利于局部麻醉组。10分制评分的平均差异在1小时时为-1.43（95%CI -2.30至-0.56，p<0.01，n = 342（治疗组175例））；6小时时为-0.52（95%CI -1.43至-0.01，p = 0.05，n = 250（治疗组130例））；24小时时为-0.31（95%CI -0.82至0.19，p = 0.86，n = 247（治疗组127例））。在报告的安全性结局中，血管迷走神经症状进入荟萃分析后，风险比为1.01（95%CI 0.64 - 1.60）。由于不一致性和不精确性，证据质量被评为“低”。
本综述支持使用局部麻醉来减轻痔套扎术后的早期疼痛。证据因样本量小和研究间存在大量异质性而受到限制。
PROSPERO（ID CRD42022322234）
