Zhu Yu-Jia, Shi Yu-Ting, Shi Sai-Ya, Xu Li
The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, P.R. China.
Department of Anorectal Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, P.R. China.
Ann Med. 2025 Dec;57(1):2556292. doi: 10.1080/07853890.2025.2556292. Epub 2025 Sep 12.
Pain is a common complication after haemorrhoid surgery. In addition to anaesthetic methods, surgical techniques and postoperative interventions, surgeons also use intraoperative adjuncts to alleviate postoperative pain. This study aims to evaluate the effectiveness and safety of methylene blue in reducing postoperative pain in haemorrhoid patients.
A search was conducted in PubMed, Embase, Cochrane Library and Web of Science for randomized controlled trials (RCTs) up until 9 December 2024, involving methylene blue use for pain relief after haemorrhoid surgery. Two reviewers independently assessed the study eligibility, extracted data and evaluated the risk of bias. Data analysis was performed using Stata 18 software. The primary outcome was the visual analogue scale (VAS) pain scores at different time points within 14 days postoperatively. Secondary outcomes included the number of patients requiring analgesics and the occurrence of complications.
358 articles were retrieved and six studies involving 598 patients were included after screening. Compared with the control group, the use of methylene blue reduced pain within 12 h postoperatively(WMD -1.582, 95% CI -2.834 to -0.330, = .013), as well as on day 2 (WMD -1.441, 95% CI - 1.874 to -1.008, < .0001), day 3 (WMD -0.975, 95% CI -1.309 to -0.641, < .0001), day 5(WMD -0.786, 95% CI -1.094 to -0.478, = .028) and day 7 (WMD -0.679, 95% CI -1.257 to -0.101, = .021), decreased the number of patients using analgesics(RR 0.293, 95% CI 0.203 to 0.422, < .0001) and did not increase the incidence of complications(RR 0.65, 95% CI 0.39-1.10, = .111) such as urinary retention, secondary haemorrhage, pruritus, temporary incontinence, wound infection, or local skin reactions.
This study shows that methylene blue can reduce postoperative pain, decrease analgesic use and does not increase complications after haemorrhoid surgery.
疼痛是痔疮手术后常见的并发症。除麻醉方法、手术技术和术后干预措施外，外科医生还会在术中使用辅助手段来减轻术后疼痛。本研究旨在评估亚甲蓝在减轻痔疮患者术后疼痛方面的有效性和安全性。
截至2024年12月9日，在PubMed、Embase、Cochrane图书馆和科学网中检索关于亚甲蓝用于痔疮手术后疼痛缓解的随机对照试验（RCT）。两名 reviewers 独立评估研究的 eligibility，提取数据并评估偏倚风险。使用Stata 18软件进行数据分析。主要结局是术后14天内不同时间点的视觉模拟量表（VAS）疼痛评分。次要结局包括需要使用镇痛药的患者数量和并发症的发生情况。
共检索到358篇文章，经筛选纳入6项研究，涉及598例患者。与对照组相比，使用亚甲蓝可降低术后12小时内的疼痛（加权均数差[WMD] -1.582，95%置信区间[CI] -2.834至-0.330，P = 0.013），以及术后第2天（WMD -1.441，95% CI -1.874至-1.008，P < 0.0001）、第3天（WMD -0.975，95% CI -1.309至-0.641，P < 0.0001）、第5天（WMD -0.786，95% CI -1.094至-0.478，P = 0.028）和第7天（WMD -0.679，95% CI -1.257至-0.101，P = 0.021）的疼痛，减少使用镇痛药的患者数量（风险比[RR] 0.293，95% CI 0.203至0.422，P < 0.0001），且不会增加诸如尿潴留、继发性出血、瘙痒、暂时性失禁、伤口感染或局部皮肤反应等并发症的发生率（RR 0.65，95% CI 0.39 - 1.10，P = 0.111）。
本研究表明，亚甲蓝可减轻痔疮手术后的疼痛，减少镇痛药的使用，且不会增加并发症的发生。
