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Local Anaesthesia Alone Versus Regional or General Anaesthesia in Excisional Haemorrhoidectomy: A Systematic Review and Meta-Analysis

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Abstract

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.

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Funding

WX, WM and AB are supported by the Health Research Council of New Zealand’s Clinical Research Training Fellowship (Grant Numbers 19/004, 18/013, 17/330, respectively).

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Authors and Affiliations

  1. Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, The University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand

    Weisi Xia, Hoani S. MacFater, Wiremu S. MacFater, Bacil F. Otutaha, Ahmed W. H. Barazanchi & Andrew G. Hill

  2. Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia

    Tarik Sammour

  3. Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand

    Andrew G. Hill

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  1. Weisi Xia
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  2. Hoani S. MacFater
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Correspondence to Weisi Xia.

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Electronic supplementary material

Below is the link to the electronic supplementary material.

Online Resource 1: Risk of Bias Assessment (DOCX 13 kb)

Online Resource 2a: Funnel Plot for Need for Rescue Analgesia (PDF 13 kb)

Online Resource 2b: Funnel Plot for Urinary Retention in Local Anaesthesia versus Regional Anaesthesia (PDF 13 kb)

268_2020_5555_MOESM4_ESM.pdf

Online Resource 2c: Funnel Plot for Intra-Operative Hypotension in Local Anaesthesia versus Regional Anaesthesia (PDF 13 kb)

Online Resource 2d: Funnel Plot for Headache in Local Anaesthesia versus Regional Anaesthesia (PDF 13 kb)

Online Resource 2e: Funnel Plot for Nausea or Vomiting in Local Anaesthesia verses Regional Anaesthesia (PDF 13 kb)

Online Resource 3: Rescue Analgesia Requirements Between Local Anaesthesia versus Regional Anaesthesia (PDF 117 kb)

Online Resource 4a: GRADE Evidence Profile for Local versus Regional Anaesthesia (DOCX 43 kb)

Online Resource 4b: GRADE Evidence Profile for Local versus General Anaesthesia (DOCX 32 kb)

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Xia, W., MacFater, H.S., MacFater, W.S. et al. Local Anaesthesia Alone Versus Regional or General Anaesthesia in Excisional Haemorrhoidectomy: A Systematic Review and Meta-Analysis. World J Surg 44, 3119–3129 (2020). https://doi.org/10.1007/s00268-020-05555-6

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  • DOI: https://doi.org/10.1007/s00268-020-05555-6

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