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Efficacy of Cholestyramine Ointment in Reduction of Postoperative Pain and Pain during Defecation after Open Hemorrhoidectomy: Results of a Prospective, Single-center, Randomized, Double-blind, Placebo-controlled Trial

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Abstract

Background

The aim of the present study was to evaluate the efficacy of cholestyramine ointment (15 %) in reducing postoperative pain at rest and during defecation after open hemorrhoidectomy.

Methods

A total of 91 patients with third and fourth degree hemorrhoids undergoing open hemorrhoidectomy were included in this prospective, double-blind, randomized controlled trial. The patients were randomly assigned to either cholestyramine ointment or placebo immediately after surgery, 12 h after surgery, and then every 8 h for 14 days. The primary outcomes were intensity of pain at rest and during defecation, measured with a visual analog scale, and the analgesic requirement, measured by amount of tramadol consumption.

Results

The cholestyramine group had less postoperative pain than the placebo group at the 24th hour (1.84 ± 2.54 vs. 4.07 ± 3.35; P = 0.001) and 48th hour (0.18 ± 0.88 vs. 3.57 ± 3.45; P < 0.001) and less pain during defecation starting at the 48th hour (2.28 ± 2.96 vs. 4.77 ± 4.09; P = 0.001). Similarly, the average tramadol consumption at hours 24 and 48 was significantly lower for the cholestyramine group (5.32 ± 21.45 vs. 43.18 ± 61.56 mg at 24 h, and 4.48 ± 16.65 vs. 57.63 ± 65.47 mg at 48 h; P < 0.001). The only adverse event was pruritus, which had a lower frequency in the cholestyramine group but the difference was not significant until postoperative week 4 (P < 0.001).

Conclusions

Compared with placebo, cholestyramine ointment (15 %) reduced postoperative pain at rest and on defecation, and consequently lowered the analgesic requirement after open hemorrhoidectomy.

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Acknowledgments

This research is recorded under trial registration number: IRCT138803091627N2. The study was funded by the Vice chancellor of research of Mazandaran University of Medical Sciences. The authors are grateful to Dr. Mohammad Reza Rouini for technical support, Dr. Nematollah Ahangar for assistance in literature review, and Drs. Mohamadpor and Maasoomeh Abolghasemi Bizaki for assistance in data analysis.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, 18th Kilometer Farahabad Boulevard, 48175861, Sari, Mazandaran Province, Iran

    Shahram Ala & Banafsheh Rezaei

  2. Department of Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran

    Fariborz Eshghi & Payam Fazel

  3. Department of Pharmaceutical Sciences, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran

    Reza Enayatifard & Roja Hadianamrei

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  1. Shahram Ala
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  2. Fariborz Eshghi
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  3. Reza Enayatifard
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  4. Payam Fazel
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  5. Banafsheh Rezaei
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Correspondence to Shahram Ala.

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Ala, S., Eshghi, F., Enayatifard, R. et al. Efficacy of Cholestyramine Ointment in Reduction of Postoperative Pain and Pain during Defecation after Open Hemorrhoidectomy: Results of a Prospective, Single-center, Randomized, Double-blind, Placebo-controlled Trial. World J Surg 37, 657–662 (2013). https://doi.org/10.1007/s00268-012-1895-3

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