Related Experiment Video
Updated: Nov 17, 2025
Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery
Published on: June 23, 2023
Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis
Francesco Mongelli1, Giorgio Treglia, Davide La Regina
11 Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland 2 Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland 3 Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
Background:
Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, especially in a surgical day care setting.
Objective:
The aim of this study was to investigate the use of pudendal nerve block in patients undergoing hemorrhoidectomy.
Data Sources:
PubMed, Google Scholar, Cochrane Library, and Web of Science databases were searched up to December 2020.
Study Selection:
Randomized trials evaluating the pudendal nerve block effect in patients undergoing hemorrhoidectomy were selected.
Interventions:
Hemorrhoidectomy under general or spinal anesthesia with or without pudendal nerve block was performed.
Main Outcome Measures:
Opioid consumption, pain on the visual analogue scale, length of hospital stay, and readmission rate were the main outcomes of interest and were plotted by using a random-effects model.
Results:
The literature search revealed 749 articles, of which 14 were deemed eligible. A total of 1214 patients were included, of whom 565 received the pudendal nerve block. After hemorrhoidectomy, patients in the pudendal nerve block group received opioids less frequently (relative risk, 0.364; 95% CI, 0.292-0.454, p < 0.001) and in a lower cumulative dose (standardized mean difference, -0.935; 95% CI, -1.280 to -0.591, p < 0.001). Moreover, these patients experienced less pain at 24 hours (standardized mean difference, -1.862; 95% CI, -2.495 to -1.228, p < 0.001), had a shorter length of hospital stay (standardized mean difference, -0.742; 95% CI, -1.145 to -0.338, p < 0.001), and had a lower readmission rate (relative risk, 0.239; 95% CI, 0.062-0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary end point, and the overall evidence quality was judged "high."
Limitations:
Occurrence of publication bias among some secondary end points and heterogeneity are the main limitations of this study.
Conclusions:
This systematic review and meta-analysis show significant advantages of pudendal nerve block use. A reduction in opioid consumption, postoperative pain, complications, and length of stay can be demonstrated. Despite the limitations, pudendal nerve block in patients undergoing hemorrhoidectomy should be considered.
