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Comparison of topical anesthetic cream (EMLA) and diclofenac suppository for pain relief after hemorrhoidectomy: a randomized clinical trial

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Abstract

Purpose

We compared the efficacy and side effects of diclofenac and a topical eutectic mixture of local anesthetics (EMLA) for pain relief after hemorrhoidectomy.

Methods

Ninety patients, nominated for elective hemorrhoidectomy, were recruited for this randomized clinical trial and were randomly categorized into three groups (30 patients in each group). After surgery, the patients in the first group received one 100 mg diclofenac suppository, those in the second group received 5 g of EMLA, and those in the third group received 5 g of petrolatum ointment (control group). The pain intensity was measured using a visual analog scale (VAS). Twenty-five mg of intramuscular pethidine was administered upon the patient’s request. Pain measurements were performed on the patient’s transfer to the recovery ward, 2 h after surgery, the evening and the morning after surgery.

Results

The EMLA group yielded the lowest VAS score on transfer to recovery and at 2 h after surgery (p < 0.05). The diclofenac group reported the lowest VAS score in the evening and the morning after surgery (p < 0.05).

Conclusions

Topical use of an EMLA cream is appropriate for short-term pain control following hemorrhoidectomy, while diclofenac yields a more sustainable pain control.

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References

  1. Nisar PJ, Scholefield JH. Managing haemorrhoids. BMJ. 2003;327(7419):847–51.

    Article  PubMed  Google Scholar 

  2. Hachiro Y, Kunimoto M, Abe T, Kitada M, Ebisawa Y. Aluminum potassium sulfate and tannic acid (ALTA) injection as the mainstay of treatment for internal hemorrhoids. Surg Today. 2011;41(6):806–9.

    Article  PubMed  CAS  Google Scholar 

  3. Perrotti P, Dominici P, Grossi E, Cerutti R, Antropoli C. Topical nifedipine with lidocaine ointment versus active control for pain after hemorrhoidectomy: results of a multicentre, prospective, randomized, double-blind study. Can J Surg. 2010;53(1):17–24.

    PubMed  Google Scholar 

  4. Kanellos I, Zacharakis E, Christoforidis E, Angelopoulos S, Kanellos D, Pramateftakis MG, Betsis D. Usefulness of lateral internal sphincterotomy in reducing postoperative pain after open hemorrhoidectomy. World J Surg. 2005;29(4):464–8.

    Article  PubMed  Google Scholar 

  5. Davies J, Duffy D, Boyt N, Aghahoseini A, Alexander D, Leveson S. Botulinum toxin (botox) reduces pain after hemorrhoidectomy: results of a double-blind, randomized study. Dis Colon Rectum. 2003;46(8):1097–102.

    Article  PubMed  Google Scholar 

  6. Wasvary HJ, Hain J, Mosed-Vogel M, Bendick P, Barkel DC, Klein SN. Randomized, prospective, double-blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy. Dis Colon Rectum. 2001;44(8):1069–73.

    Article  PubMed  CAS  Google Scholar 

  7. Nicholson TJ, Armstrong D. Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing. Dis Colon Rectum. 2004;47(5):711–6.

    Article  PubMed  Google Scholar 

  8. Balfour L, Stojkovic SG, Botterill ID, Burke DA, Finan PJ, Sagar PM. A randomized, double-blind trial of the effect of metronidazole on pain after closed hemorrhoidectomy. Dis Colon Rectum. 2002 Sep;45(9):1186–90. (Discussion 1190–1).

    Article  PubMed  Google Scholar 

  9. Kisli E, Başer M, Güler O, Aydin M, Kati I. Comparison of the analgesic effect of betamethasone and diclofenac potassium in the management of postoperative haemorrhoidectomy pain. Acta Chir Belg. 2005;105(4):388–91.

    PubMed  CAS  Google Scholar 

  10. Goldstein ET, Williamson PR, Larach SW. Subcutaneous morphine pump for postoperative hemorrhoidectomy pain management. Dis Colon Rectum. 1993;36(5):439–46.

    Article  PubMed  CAS  Google Scholar 

  11. Shiau JM, Su HP, Chen HS, Hung KC, Lin SE, Tseng CC. Use of a topical anesthetic cream (EMLA) to reduce pain after hemorrhoidectomy. Reg Anesth Pain Med. 2008;33(1):30–5.

    PubMed  CAS  Google Scholar 

  12. Lim NL, Lo WK, Chong JL, Pan AX. Single dose diclofenac suppository reduces post-cesarean PCEA requirements. Can J Anaesth. 2001;48(4):383–6.

    Article  PubMed  CAS  Google Scholar 

  13. Dahl V, Hagen IE, Sveen AM, Norseng H, Koss KS, Steen T. High-dose diclofenac for postoperative analgesia after elective caesarean section in regional anaesthesia. Int J Obstet Anesth. 2002;11(2):91–4.

    Article  PubMed  CAS  Google Scholar 

  14. Evans JM, McMahon AD, McGilchrist MM, White G, Murray FE, McDevitt DG, MacDonald TM. Topical non-steroidal anti-inflammatory drugs and admission to hospital for upper gastrointestinal bleeding and perforation: a record linkage case–control study. BMJ. 1995;311(6996):22–6.

    Article  PubMed  CAS  Google Scholar 

  15. Ferguson JA, Heaton JR. Closed hemorrhoidectomy. Dis Colon Rectum. 1959;2:176–9.

    Article  PubMed  CAS  Google Scholar 

  16. Lyons JB, Niazi A, Lowe D, Sheehan SJ, Moriarty J. A prospective, randomised trial of preoperative rectal diclofenac: are we closing the gate after the horse has gone? Ir J Med Sci. 2003;172(3):112–4.

    Article  PubMed  CAS  Google Scholar 

  17. Dahl JB, Kehlet H. Non-steroidal anti-inflammatory drugs: rationale for use in severe postoperative pain. Br J Anaesth. 1991;66(6):703–12.

    Article  PubMed  CAS  Google Scholar 

  18. Flygare U, Seuri M, Hurme J, Wuolijoki E. Relief of spasm with diclofenac. Clin Rheumatol. 1988;7(1):124–5.

    Article  PubMed  CAS  Google Scholar 

  19. Blanke W, Hallern BV. Sharp wound debridement in local anaesthesia using EMLA cream: 6 years’ experience in 1084 patients. Eur J Emerg Med. 2003;10(3):229–31.

    Article  PubMed  Google Scholar 

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Correspondence to Mojgan Rahimi.

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Rahimi, M., Kazemeini, A.R., Pourtabatabaei, N. et al. Comparison of topical anesthetic cream (EMLA) and diclofenac suppository for pain relief after hemorrhoidectomy: a randomized clinical trial. Surg Today 42, 1201–1205 (2012). https://doi.org/10.1007/s00595-012-0222-9

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  • DOI: https://doi.org/10.1007/s00595-012-0222-9

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