Not recommended for Haemorrhoid Surgery

Not recommended for haemorrhoid surgery

Pre-operative not recommended	Systemic analgesia –        Gabapentinoids (Grade D) because there is no procedure-specific evidence and because the benefit:risk ratio is not sufficiently favourable for this ambulatory procedure –        Ketamine (Grade D) because there is no procedure-specific evidence and because the benefit:risk ratio is not sufficiently favourable for this ambulatory procedure –       Dextromethorphan (Grade D) based on inconclusive procedure-specific and transferable evidence –        Strong opioids, including transdermal fentanyl (Grade D) due to a lack of procedure-specific and transferable evidence Topical therapies –        Topical EMLA (Grade B) based on limited procedure-specific evidence showing a lack of analgesic benefit LA for analgesia –        Caudal LA or opioid (Grade D), due to an insufficiently favourable benefit:risk ratio for this ambulatory procedure Adjuncts to spinal anaesthesia –        Addition of adjuncts to the spinal solution (Grade D), due to potential side-effects
Intra-operative not recommended	Alternative interventions –        Botulinum toxin (Grade D), due to inconsistent procedure-specific evidence for analgesic benefit in the postoperative period Adjuncts to surgery –        Lateral sphincterotomy (Grade D) for analgesia due to limited and inconsistent procedure-specific evidence –        Anal dilator (Grade D) for analgesia based on limited procedure-specific evidence
Postoperative not recommended	Systemic analgesia –        Gabapentinoids (Grade D) because there is no procedure-specific evidence and because the benefit:risk ratio is not sufficiently favourable for this ambulatory procedure –        Ketamine (Grade D) because there is no procedure-specific evidence and because the benefit:risk ratio is not sufficiently favourable for this ambulatory procedure –       Dextromethorphan (Grade D) based on inconclusive procedure-specific and transferable evidence Alternative interventions –        Botulinum toxin (Grade D), due to inconsistent procedure-specific evidence for analgesic benefit in the postoperative period –        Flavonoids (Grade D), because of limited and inconclusive procedure-specific evidence –        Anal sphincter relaxant (Grade D) for analgesia based on limited procedure-specific evidence Topical therapies and haemostatic dressings –        Topical glyceryl trinitrate (Grade D), due to inconsistent procedure-specific data –        Topical calcium channel blocker (Grade D), due to limited procedure-specific evidence –        Calcium alginate dressings (Grade D), due to limited procedure-specific evidence