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

TL;DR

This review finds that using local anesthetic during hemorrhoid banding reduces early post-procedure pain, though evidence is limited by small studies.

Contribution

A systematic review and meta-analysis evaluating the analgesic effect of local anesthetic in hemorrhoid banding.

Findings

Local anesthetic reduced pain scores at 1 hour post-procedure compared to no analgesia.

Evidence quality was rated as low due to inconsistency and imprecision across studies.

No significant difference in vasovagal symptoms between groups.

Abstract

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)

The online version contains supplementary material available at 10.1007/s00384-024-04609-8.

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