AlAwadhi Kalthoum, Allafi Fahad A, Almukaimi Bader A, Alkandari Ahmad, Alenezi Saoud A, Alenezi Awatef, Alenezi Shaikhah, Alenezi Sara, Alenezi Nasser, Fahiman Abdullah, Alsalem Abdulwahab, Alotaibi Muteb
Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT.
General Surgery, Jahra Hospital, Jahra, KWT.
Cureus. 2024 Aug 8;16(8):e66423. doi: 10.7759/cureus.66423. eCollection 2024 Aug.
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.
痔切除术后疼痛是患者和医生都关注的并发症，主要原因是肛周皮肤剥离以及该区域复杂的神经支配。因此，我们的目的是探讨复方利多卡因乳膏在痔切除患者中的镇痛效果和安全性。我们对五个电子数据库（PubMed、Scopus、Web of Science、Embase、Cochrane）进行了全面检索，检索时间从建库至2024年7月6日。使用Cochrane随机试验偏倚风险工具的第2版偏倚风险（RoB - 2）进行偏倚风险评估。仅纳入随机对照试验（RCT）。我们感兴趣的结局指标包括使用视觉模拟量表（VAS）评分进行疼痛评估、患者满意度、哌替啶剂量、哌替啶需求频率以及单次导尿情况。我们使用RevMan软件进行统计分析。二分数据合并为相对危险度（RR），连续数据合并为平均差（MD）。我们的综述纳入了四项RCT。两项RCT显示总体偏倚风险较低，一项RCT显示偏倚风险高，最后一项显示存在一些问题。我们的分析表明，在到达恢复室时以及手术当天晚上，两组之间存在显著差异，复方利多卡因乳膏组优于对照组（MD = -1.76，95%CI（-3.17，-0.36），p = 0.01；MD = -1.65，95%CI（-2.48，-0.81），p = 0.0001）。然而，在术后第二天早上，两组之间无显著差异（MD = -0.9，95%CI（-2.02，0.21），p = 0.11）。此外，与未使用复方利多卡因乳膏的患者相比，使用该乳膏的患者报告的患者满意度更高。然而，两组在导尿使用方面无显著差异。总之，我们的研究表明，痔切除术后在肛周区域涂抹复方利多卡因乳膏可有效减轻术后疼痛，减少所需阿片类药物剂量和患者需求。这最终提高了患者满意度。然而，仍需要进一步研究来证实这些发现。
