Abstract
Background
Spasm of the internal anal sphincter is considered to be one of the causes of pain in anal diseases. We have evaluated the effects of topical diltiazem on postoperative pain after hemorrhoidectomy.
Methods
Sixty-two patients were randomly assigned to receive a 2 % diltiazem gel (n = 32) or a placebo gel (n = 30) after hemorrhoidectomy. Patients applied the gel to the anal region three times per day for 14 days. Pain both in the resting state and on defecation ranged from 0 to 10 on a numerical rating scale, and the number of prescribed loxoprofen tablets (Loxonin) were recorded and confirmed daily by telephone. Any morbidity during the follow-up period was recorded.
Results
Both pain scores during defecation and the number of analgesic tablets consumed tended to be lower in the diltiazem group, although they did not reach statistical significance (P = 0.09, P = 0.12, respectively). Total number of complications was significantly higher in the diltiazem group, but each incidence of complications, including itching sensation, headache, and dizziness was not statistically different.
Conclusions
Perianal application of 2 % diltiazem gel after hemorrhoidectomy has the potential to reduce postoperative pain during defecation.
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References
Loder PB, Kamm MA, Nicholls RJ et al (1994) Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg 81:946–954
Carapeti EA, Kamm MA, McDonald PJ et al (1998) Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet 17:169–172
Ala S, Saeedi M, Eshghi F et al (2008) Topical metronidazole can reduce pain after surgery and pain on defecation in postoperative hemorrhoidectomy. Dis Colon Rectum 51:235–238
Wasvary HJ, Hain J, Mosed-Vogel M et al (2001) Randomized, prospective, double-blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy. Dis Colon Rectum 44:1069–1073
Elton C, Sen P, Montgomery AC (2001) Initial study to assess the effects of topical glyceryl trinitrate for pain after haemorrhoidectomy. Int J Surg Invest 2:353–357
Hwang DY, Yoon SG, Kim HS et al (2003) Effect of 0.2 percent glyceryl trinitrate ointment on wound healing after a hemorrhoidectomy: results of a randomized, prospective, double-blind, placebo-controlled trial. Dis Colon Rectum 46:950–954
Tan KY, Sng KK, Tay KH et al (2006) Randomized clinical trial of 0.2 per cent glyceryl trinitrate ointment for wound healing and pain reduction after open diathermy haemorrhoidectomy. Br J Surg 93:1464–1468
Karanlik H, Akturk R, Camlica H et al (2009) The effect of glyceryl trinitrate ointment on posthemorrhoidectomy pain and wound healing: results of a randomized, double-blind, placebo-controlled study. Dis Colon Rectum 52:280–285
Brisinda G, Maria G, Bentivoglio AR et al (1999) A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 341:65–69
Patti R, Almasio PL, Muggeo VM et al (2005) Improvement of wound healing after hemorrhoidectomy: a double-blind, randomized study of botulinum toxin injection. Dis Colon Rectum 48:2173–2179
Patti R, Almasio PL, Arcara M et al (2006) Botulinum toxin vs. topical glyceryl trinitrate ointment for pain control in patients undergoing hemorrhoidectomy: a randomized trial. Dis Colon Rectum 49:1741–1748
Silverman R, Bendick PJ, Wasvary HJ (2005) A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy. Dis Colon Rectum 48:1913–1916
Amoli HA, Notash AY, Shahandashti FJ et al (2011) A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain. Colorectal Dis 13:328–332
Tsunoda A, Sada H, Sugimoto T et al (2011) Randomized controlled trial of bipolar diathermy vs ultrasonic scalpel for closed hemorrhoidectomy. World J Gastrointest Surg 27:147–152
Armstrong DN, Ambroze WL, Schertzer ME et al (2001) Harmonic Scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum 44:558–564
Knight JS, Birks M, Farouk R (2001) Topical diltiazem ointment in the treatment of chronic anal fissure. Br J Surg 88:553–556
Carapeti EA, Kamm MA, Evans BK et al (1999) Topical diltiazem and bethanechol decrease anal sphincter pressure without side effects. Gut 45:719–722
Acknowledgments
The authors are grateful to Megumi Onishi for prescribing the gel; to Mariko Kawana and Yuka Kobori (all pharmacists) for evaluating pain scores, analgesic requirements, and patient satisfaction scores; and Shin-Etsu Chemical Co., Ltd for advice on producing a placebo gel. This study is recorded under Registration Number: UMIN000010658 R000012465.
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Sugimoto, T., Tsunoda, A., Kano, N. et al. A Randomized, Prospective, Double-blind, Placebo-Controlled Trial of the Effect of Diltiazem Gel on Pain After Hemorrhoidectomy. World J Surg 37, 2454–2457 (2013). https://doi.org/10.1007/s00268-013-2124-4
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DOI: https://doi.org/10.1007/s00268-013-2124-4