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Updated: Jul 13, 2025

Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery
Published on: June 23, 2023
Comparison of ointment-based agents after excisional procedures for hemorrhoidal disease: a network meta-analysis of
Konstantinos Perivoliotis1, Charito Chatzinikolaou2, Dimitrios Symeonidis3
1Department of Surgery, General Hospital of Volos, Polymeri 134, 38222, Volos, Greece. kperi19@gmail.com.
Introduction:
Efficient postoperative pain control is important after hemorrhoidal surgery. Although several locally applied medications have been used, current evidence regarding the optimal strategy is still conflicting. This network meta-analysis assessed analgesic efficacy and safety of the various topical medications in patients submitted to excisional procedures for hemorrhoids.
Methods:
The present study followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The last systematic literature screening was performed at 15 June 2023. Comparisons were based on a random effects multivariate network meta-analysis under a Bayesian framework.
Results:
Overall, 26 RCTs and 2132 patients were included. Regarding postoperative pain, EMLA cream (surface under the cumulative ranking curve (SUCRA) 80.3%) had the highest ranking at 12-h endpoint, while aloe vera cream (SUCRA 82.36%) scored first at 24 h. Metronidazole ointments had the highest scores at 7 and 14 days postoperatively. Aloe vera had the best analgesic profile (24-h SUCRA 84.8% and 48-h SUCRA 80.6%) during defecation. Lidocaine (SUCRA 87.9%) displayed the best performance regarding overall morbidity rates.
Conclusions:
Due to the inconclusive results and several study limitations, further RCTs are required.
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