In Diseases of the Colon & Rectum, Mongelli et al published their systematic review and meta-analysis evaluating the effect of pudendal nerve blocks (PNB) on postoperative pain in patients undergoing traditional hemorrhoidectomy (Dis Colon Rectum 2021;64:617-631).
The researchers scoured major research databases (PubMed, Google Scholar, Cochrane Library and Web of Science) through December 2020, and identified randomized trials comparing PNB and any other treatment without PNB in patients undergoing surgical management for hemorrhoidal disease. Studies evaluating nonhemorrhoidal disease or with a sample size of fewer than 10 patients were excluded. The authors then used a random effects model to evaluate opioid consumption, pain on the Visual Analogue Scale, hospital length of stay and readmission rate. This approach allows for variable treatment effects identified in individual studies included in the meta-analysis to influence the average treatment effect identified in the meta-analysis. The approaches to PNB (nerve stimulation, ultrasound guidance and anatomic landmarks), type of anesthetic used, open versus closed hemorrhoidectomy, and control groups (placebo PNB vs. no PNB), varied among the studies. Postoperative pain values or opioid consumption were provided by all included studies