Analgesic Efficacy of EMLA Cream Among Patients Undergoing Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Post-hemorrhoidectomy pain is a concerning complication for patients and doctors, mainly due to perianal skin dissection and the complex innervation of the area. Therefore, our aim is to explore the analgesic efficacy and safety of EMLA cream among patients undergoing hemorrhoidectomy. We conducted a comprehensive search of five electronic databases (PubMed, Scopus, Web of Science, Embase, Cochrane) from inception until July 6, 2024. A risk of bias assessment was performed using the Risk of Bias Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2). Only randomized controlled trials (RCTs) were included. Our outcomes of interest were pain assessment using the Visual Analogue Scale (VAS) score, patient satisfaction, meperidine dosage, frequency of meperidine requests, and single urinary catheterization. We used RevMan software to conduct the statistical analysis. Dichotomous data were pooled as relative risk (RR), while continuous data were pooled as mean difference (MD). Four RCTs were included in our review. Two RCTs showed a low overall risk of bias, while one RCT showed a high risk, and the last one showed some concerns. Our analysis showed a significant difference between the two groups, favoring the EMLA group over the control group, upon arrival at the recovery room and at night on the day of the operation (MD=-1.76, 95% CI (-3.17, -0.36), p=0.01 and MD=-1.65, 95% CI (-2.48, -0.81), p=0.0001, respectively). However, there was no significant difference between the two groups in the morning on the day after the operation (MD=-0.9, 95% CI (-2.02, 0.21), p=0.11). Moreover, patients who used EMLA cream reported increased patient satisfaction compared to those who did not. However, there was no significant difference between both groups in terms of the use of urinary catheterizations. In conclusion, our study showed that applying EMLA cream over the perianal area after hemorrhoidectomy can effectively reduce postoperative pain and decrease the required opioid dosage and patient requests. This ultimately leads to increased patient satisfaction. However, further studies are still required to confirm these findings.