From the Guidelines
Lidocaine and prilocaine do not have a recommended role in the treatment of complicated hemorrhoids, as there is no evidence to support their use in this context, according to the most recent guidelines 1.
Treatment Overview
The treatment of hemorrhoids typically involves non-operative management as first-line therapy, with dietary and lifestyle changes, such as increased fiber and water intake, and adequate bathroom habits 1.
- Flavonoids may be suggested to relieve symptoms, although the evidence is moderate and the recommendation is weak 1.
- Topical muscle relaxants, like nifedipine, may be considered for thrombosed or strangulated hemorrhoids, but the evidence is low-quality and the recommendation is weak 1.
Local Anesthetics
Local anesthetics, such as lidocaine and prilocaine, are not recommended for the treatment of complicated hemorrhoids, as there is no evidence to support their use in this context 1.
- The guidelines suggest that other topical agents, including NSAIDs, topical steroids, and injection of local anesthetics, should not be used for complicated hemorrhoids due to a lack of evidence 1.
Pain Management
Pain management is crucial in the treatment of hemorrhoids, especially for severe or persistent cases.
- Topical creams or ointments, such as those containing lidocaine or prilocaine, may provide temporary pain relief, but their use should be limited to short-term relief and not as a definitive treatment.
- Other pain management options, such as flavonoids or topical muscle relaxants, may be considered, but the evidence is limited, and the recommendations are weak 1.
From the Research
Treatment of Hemorrhoids with Lidocaine and Prilocaine
- Lidocaine and prilocaine are used to treat hemorrhoids, particularly for pain management after hemorrhoidectomy or rubber band ligation 2, 3.
- Topical lidocaine has been shown to reduce short-term analgesia use after hemorrhoid banding 2.
- A combination of lidocaine and diltiazem has been associated with improved analgesia and patient satisfaction after hemorrhoid banding 2.
- EMLA cream, which contains lidocaine and prilocaine, has been used to reduce pain after hemorrhoidectomy, resulting in lower pain scores, reduced meperidine requests, and improved patient satisfaction 3.
Mechanism of Action
- Lidocaine and prilocaine work as topical anesthetics, numbing the area to reduce pain and discomfort 2, 3.
- The exact mechanism of action of lidocaine and prilocaine in treating hemorrhoids is not fully understood, but it is thought to involve the inhibition of nerve conduction and the reduction of inflammation 2, 3.
Clinical Evidence
- Studies have shown that lidocaine and prilocaine are effective in reducing pain and improving patient satisfaction after hemorrhoid treatment 2, 3, 4.
- The combination of tribenoside and lidocaine has been shown to be effective in treating hemorrhoids in women, with rapid onset of symptom relief and improved subjective and objective symptoms 4.
- Lidocaine and prilocaine have been used in various clinical settings, including postpartum women and pregnant women after the first trimester of pregnancy, with no reported adverse effects 4.