Introduction: Excisional haemorrhoidectomy remains the gold-standard treatment for grade III-IV haemorrhoids owing to the high success rate. However, post-operative pain management is an ongoing challenge. Botulinum toxin injection is thought to improve pain by targeting the internal anal sphincter spasm which occurs following haemorrhoidectomy. This systematic review and meta-analysis examines the effects of concurrent botulinum toxin injection on post-haemorrhoidectomy pain.

Methods: A search of MEDLINE, EMBASE and Cochrane Databases for randomised controlled trials (RCTs) of botulinum toxin injection compared with placebo for management of post-haemorrhoidectomy pain was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Outcomes assessed included daily post-operative pain scores assessed using an analogue scale (0-10), pain at first defecation, analgesia use, complication rates and time to return to work.

Results: A total of seven RCTs assessing 340 patients who underwent an excisional haemorrhoidectomy were included. In total, seven studies (n = 340) found significant reduction in pain post-procedure with botulinum toxin use on day 1 (mean difference, MD -1.53; 95% confidence intervals, CI -2.12, -0.94; p < 0.00001), with similar findings on day 2 and 4 (MD -1.84, 95% CI -3.28, -0.41; p = 0.01 and MD -1.63, 95% CI -2.15, -1.09; p < 0.00001, respectively). However, the analgesic effects were not seen on subsequent analyses up to day 14. Botulinum toxin was seen to be safe, with no significant difference in faecal incontinence (MD 1.05, 95% CI 0.40, 2.75; p = 0.93) or urinary retention (MD 0.37, 95% CI 0.09, 1.53; p = 0.17).

Conclusions: Botulinum toxin use for pain relief post-excisional haemorrhoidectomy is safe and effective in the initial peri-operative period; however, the results were short-lived. Further, more robust randomised controlled trials are needed to strengthen these findings and determine the utility of botulinum toxin in this setting.

Trial registration: PROSPERO Register for Systematic Reviews Registration Number - CRD42024541351 on April 29 2024.

Keywords: Analgesia; Botulinum Toxins; Hemorrhoidectomy; Pain; Post-operative.

© 2025. The Author(s).

简介： 切除痔核手术仍然是治疗III-IV度痔疮的金标准，因为其成功率较高。然而，术后疼痛管理一直是一个持续的挑战。肉毒杆菌毒素注射被认为可以通过针对痔核切除后发生的内括约肌痉挛来改善疼痛。本系统综述和元分析探讨了同时使用肉毒杆菌毒素对痔核手术后疼痛的影响。

方法： 根据系统回顾和元分析的首选报告项目（PRISMA）指南，我们检索了MEDLINE、EMBASE和Cochrane数据库中的随机对照试验（RCT），以比较肉毒杆菌毒素注射与安慰剂在痔核手术后疼痛管理方面的效果。评估的结果包括使用模拟评分量表（0-10分）评估的每日术后疼痛分数、首次排便时的疼痛、镇痛药使用情况、并发症发生率和返回工作岗位的时间。

结果： 共有7项随机对照试验纳入研究，涉及340名接受切除痔核手术的患者。总共七项研究（n = 340）发现，在术后第一天使用肉毒杆菌毒素可以显著减轻疼痛（平均差值MD为-1.53；95%置信区间CI为-2.12至-0.94，p

结论： 肉毒杆菌毒素用于切除痔核手术后的止痛在初始围术期是安全且有效的，但结果持续时间较短。需要进一步开展更严谨的随机对照试验以强化这些发现，并确定在此情况下的肉毒杆菌毒素使用价值。

临床注册： PROSPERO系统综述注册编号 - CRD42024541351，于2024年4月29日注册。

关键词： 镇痛；肉毒杆菌毒素；痔核切除术；疼痛；术后。