Description of studies

Description of studies

Literature search

• Systematic review of the literature from 1966–June 2006 using MEDLINE and EmBASE, following the protocol of the Cochrane Collaboration Haemorrhoid Surgery June 2006 Search Terms
• Inclusion of randomised studies in English, assessing analgesic interventions in haemorrhoid surgery in adults, and reporting pain on a linear analogue, verbal or numerical rating scale
  • Primary outcome measure: postoperative pain scores
  • Secondary outcome measures: supplemental analgesic requirements, other recovery outcomes (adverse effects, functional recovery)
• Identification of 207 studies of peri-operative interventions for postoperative pain following haemorrhoid surgery
• 106 studies included Haemorrhoid Surgery June 2006 Included References
• 101 studies excluded Haemorrhoid Surgery June 2006 Excluded References
• The most common reasons for exclusion were that the method of haemorrhoid removal was not surgical (35 studies), or pain scores were not reported (24 studies), or the study was not a randomised controlled trial (29 studies; see Table 1 below) Haemorrhoid Surgery June 2006 Reasons for Exclusion

Study quality assessments, levels of evidence and grades of recommendation

Recommendations are graded according to the overall level of evidence (LoE) on which the recommendations are based, which is determined by the quality and source of evidence: Levels of evidence and grades of recommendation in PROSPECT reviews (from 2006)

Click here for quality scores and levels of evidence for included procedure-specific studies: Haemorrhoid Surgery June 2006 Quality Scoring + Levels of Evidence

Quantitative analyses

No meta-analyses were performed due to a limited number of studies of homogeneous design that reported similar outcome measures. Therefore, the procedure-specific evidence was only assessed qualitatively.

Transferable evidence

Transferable evidence of analgesic efficacy from comparable procedures (e.g. anorectal surgery) or evidence of other outcomes, such as adverse effects, has been included to support the procedure-specific evidence where this is insufficient to formulate the recommendations. Several studies that were identified in the literature search reported data pooled from patients undergoing mixed surgical procedures including haemorrhoid surgery. Such studies are excluded from the procedure-specific systematic review, but have been used as additional transferable evidence in cases where the Working Group considered it appropriate.