Assessment of the efficacy and safety of pudendal nerve block in post-hemorrhoidectomy pain: A meta-analysis of randomized controlled trials

Hemorrhoid surgeries often result in significant postoperative anal pain, challenging the recovery process. This meta-analysis assessed the efficacy and safety of the pudendal nerve block (PNB), a targeted anesthesia technique, in alleviating pain after hemorrhoidectomy. Comprehensive database searches across China National Knowledge Infrastructure (CNKI), VIP Database, Wanfang Database, Chinese Biomedical Literature Database, PubMed, Embase, and The Cochrane Library identified relevant randomized controlled trials (RCTs). The meta-analysis was performed using RevMan 5.3 software and the quality of evidence for outcome measures was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results from 11 RCTs involving 897 patients with mixed hemorrhoids showed that the PNB group had significantly lower postoperative pain scores at 12 hand 24 h (P < 0.0001 for both), and a lower incidence of urinary retention (P = 0.04), compared to the group not using PNB. Additionally, a higher proportion of patients in the PNB group had hospital stays of less than one day (P = 0.0002). Although the time in the operating room was longer for the PNB group (P = 0.15), there was no statistically significant difference in the incidence of complications between the two groups (P = 0.15). These findings suggest that PNB effectively reduces postoperative pain and urinary retention in hemorrhoidectomy, facilitates shorter hospital stays, and does not increase complication rates, despite longer time in the operating room. (c) 2025 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).