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Local Anaesthesia Alone Versus Regional or General Anaesthesia in Excisional Haemorrhoidectomy: A Systematic Review and Meta-Analysis.
Xia, Weisi; MacFater, Hoani S; MacFater, Wiremu S; Otutaha, Bacil F; Barazanchi, Ahmed W H; Sammour, Tarik; Hill, Andrew G.
Affiliation
  • Xia W; Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, The University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand. w.xia@auckland.ac.nz.
  • MacFater HS; Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, The University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand.
  • MacFater WS; Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, The University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand.
  • Otutaha BF; Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, The University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand.
  • Barazanchi AWH; Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, The University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand.
  • Sammour T; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
  • Hill AG; Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, The University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand.
World J Surg ; 44(9): 3119-3129, 2020 09.
Article in En | MEDLINE | ID: mdl-32383052
BACKGROUND: Excisional haemorrhoidectomy has been traditionally performed under general or regional anaesthesia. However, these modes are associated with complications such as nausea, urinary retention and motor blockade. Local anaesthesia (LA) alone has been proposed to reduce side effects as well as to expedite ambulatory surgery. This systematic review aims to assess LA versus regional or general anaesthesia for excisional haemorrhoidectomy. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE and CENTRAL databases were searched to 13 January 2020. All randomised controlled trials comparing LA only versus regional or general anaesthesia in patients who received excisional haemorrhoidectomy were included. The main outcomes included pain, adverse effects and length of stay. RESULTS: Nine trials, consisting of six studies comparing local versus regional anaesthesia and three comparing LA versus general anaesthesia, were included. Meta-analysis showed a significantly lower relative risk for need of rescue analgesia (RR 0.32 [95% CI 0.16-0.62]), intra-operative hypotension (RR 0.17 [95% CI 0.04-0.76]), headache (RR 0.13 [0.02-0.67]) and urinary retention (RR 0.17 [95% CI 0.09-0.29]) for LA when compared with regional anaesthesia. There was mixed evidence for both regional and general anaesthesia in regard to post-operative pain. CONCLUSIONS: LA alone may be considered as an alternative to regional anaesthesia for excisional haemorrhoidectomy with reduced complications and reduction in the amount of post-operative analgesia required. The evidence for LA compared to general anaesthesia for haemorrhoidectomy is low grade and mixed.
Subject(s)

Full text: 1 Database: MEDLINE Main subject: Pain, Postoperative / Pain Management / Hemorrhoidectomy / Hemorrhoids / Anesthesia, General / Anesthesia, Local Type of study: Clinical_trials / Diagnostic_studies / Etiology_studies / Systematic_reviews Language: En Journal: World J Surg Year: 2020 Type: Article Affiliation country: New Zealand

Full text: 1 Database: MEDLINE Main subject: Pain, Postoperative / Pain Management / Hemorrhoidectomy / Hemorrhoids / Anesthesia, General / Anesthesia, Local Type of study: Clinical_trials / Diagnostic_studies / Etiology_studies / Systematic_reviews Language: En Journal: World J Surg Year: 2020 Type: Article Affiliation country: New Zealand