The effect of bupivacaine on analgesia and safety in patients undergoing hemorrhoidectomy: a meta-analysis

Aim: There is no meta-analysis reporting the analgesic effect and safety of bupivacaine in patients undergoing hemorrhoidectomy. This meta-analysis provides quantitative evidence of the effect of bupivacaine in hemorrhoidectomy. Methods: Studies were searched from PubMed, Embase, the Cochrane Library, and the Web of Science. Standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) with 95% confidence interval (CI) were used as effect indicators. Heterogeneity was assessed using the I-2 index, and sensitivity analysis was conducted to determine the effect of the single study on the pooled results. Results: A total of 18 studies were included in this meta-analysis. The pain level at 48 h was lower in the bupivacaine-combined other drug group than in the other drug group (WMD = -0.65, 95% CI: 1.18 to -0.11, and I-2 = 37.50%). Compared to the bupivacaine group, the odds of pruritus (OR = 12.11, 95% CI: 1.49-98.59, and I-2 = 0%) and urinary retention (OR = 4.45, 95% CI: 1.12-17.70, and I-2 = 0%) were higher, and the pain level at 6 h (WMD = -2.13, 95% CI: 3.22 to -1.04, and I-2 = 64.30%), at 12 h (WMD = -1.55, 95% CI: 2.19 to -0.90, and I-2 = 56.10%), and at 24 h (SMD = -1.15, 95% CI: 1.89 to -0.42, and I-2 = 82.5%) were lower in the bupivacaine-combined other drug group. Conclusion: Bupivacaine-combined other drugs had a good analgesic effect after hemorrhoidectomy, but the adverse reactions should be considered.