TOPICAL DILTIAZEM OINTMENT FOR POST-HEMORRHOIDECTOMY PAIN
Abstract
Background: Hemorrhoids are one of the most common anal pathology affecting millions of people around the world. Milligan-Morgan open hemorrhoidectomy is the most effective hemorrhoidectomy method used as gold standard procedure. Post-operative pain is recognized as a distressing complication of hemorrhoidectomy leading to increase hospital stay and psychological stress to both patient and surgeon. This study is designed to determine the efficacy of diltiazem gel in relieving pain after hemorrhoidectomy caused by anal muscle spasm. This will lead to decreased hospital stay and save both patient and surgeon from stress in postoperative period. Objective: To compare mean post-operative pain in patients undergoing hemorrhoidectomy with vs. without topical application of diltiazem gel. Methods: Total 80 patients who were diagnosed with third- and fourth-degree hemorrhoids and undergo hemorrhoidectomy were included in the study. Patients were randomly allocated to two groups using opaque sealed envelope method. Group A and B both have 40 patients in each group. Pain score was measured on visual analogue scale (VAS) by asking the patients to fill a questionnaire or by the help of the doctor. Results: The patient’s average age was 39.98±7.98 years. At 24 hours, mean pain score was significantly high in group B than group A [7.23±0.95 vs. 5.38±1.06; p=0.0005]. At 3rd post-operative day, mean pain score was significantly high in group B than group A [5±0.78 vs. 3.08±0.99; p=0.0005]. Seventy percent cases were observed in group B which required rescue analgesia. Conclusion: It is concluded that application of diltiazem ointment at perianal area with standard treatment considerably decreases pain after haemorrhoidectomy. Keywords: Hemorrhoids; Hemorrhoidectomy; Diltiazem gelReferences
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012 May 7;18(17):2009-17.
Chucha A, Singh R, Agarwal P. Management of hemorrhoids. India J Clinical Prac. 2014 Nov;25(6):256.
Xiang F, Feng JJ. Postoperative analgesic effect of methylene blue compound in anal diseases. Int J Clin Exp Med. 2016;9(3):6302-8.
Lim DR, Cho DH, Lee JH, Moon JH. Comparison of a hemorrhoidectomy with ultrasonic scalpel versus a conventional hemorrhoidectomy. Ann Coloproctol. 2016;32(3):111-6.
Suchdev S, Ghayassuddin M, Younus SM, Mirani AJ, Ghias N, Qazi A, et al. Calcium channel blockers for pain relief after haemorrhoidectomy; a randomized controlled trial from Karachi, Pakistan. Pak J Surg. 2014;30(2):187-92.
Lunniss PJ. The anus and anal canal. In: Williams NS, Bulstrode CJK, Ronan O’ Connell P. Bailey and Love’s short practice of surgery. London: Edward Arnold; 2008. P. 1240-70.
Uzzaman M, Rafay MS, Department of General Surgery, Croydon Hospital, UK. A brief literature review on the management of post-haemorrhoidectomy pain. UK: Surgical Techniques Development; 2011. P. 1-e32.
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.
Kaidar-Person O, Person B, Wexner SD. "Hemorrhoidal disease: a comprehensive review. J Am Coll Surg. 2007;204(1):102–17.
National Institute of Diabetes and Digestive and Kidney Diseases. London: NIDDKD; February 2016.
Chauhan A, Tiwari S, Mishra VK, Bhatia PK. Comparison of internal sphincterotomy with topical diltiazem for post-hemorrhoidectomy pain relief: a prospective randomized trial. J Postgrad Med. 2009 Jan 1;55(1):22.
Lorenzo-Rivero S. "Hemorrhoids: diagnosis and current management". Am Surg. 2009;75(8):635–42.
Goligher JC. Surgery of the anus, rectum and colon. 5th ed. London: Bailliere Tindall; 1984.
Khoury GA, Lake SP, Lewis MC and Lewis AA. A randomizedtrial to compare single with multiple phenol injection treatmentfor haemorrhoids. Br J Surg. 1985;72:741-2.
Malik AM, Zafar MR, Abbasi SA. Submucosal closed and open(ligation excision) hemorrhoidectomy (a comparison of thetwo methods). Pak Armed Forces Med J. 1997;47:4-7.
Chauhan A, Thomas S, Bishnoi PK, Hadke NS. Randomizedcontrolled trial to assess the role of raised anal pressures in thepathogenesis of symptomatic early hemorrhoids. Dig Surg. 2007;24(1):28e32.
Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemor- rhoids: pathology, pathophysiology and aetiology. Br J Surg. 1994;81:946-e954.
Staneva-Stoytcheva D, Venkova K. Effects of the calcium antagonistsdiltiazem, verapamil and nitrendipine on thecontractile responses of Guinea-pig isolated ileum to electricalstimulation or carbachol. J Pharm Pharmacol. 1992;44:321-e325.
Morales-Olivas FJ, Cortijo J, Esplugues JV. EVect ofverapamil and diltiazem on isolated gastro-oesophagealsphincter of the rat. J Pharm Pharmacol. 1985;37:208-e209.
Amoli HA, Notash AY, Shahandashti FJ, Kenari AY, Ashraf H. A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on post-hemorrhoidectomy pain. Colorectal Dis. 2011 Mar;13(3):328-32.
Huang YJ, Chen CY, Chen RJ, Kang YN, Wei PL. Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials. Asian J Surg. 2018 Sep;41(5):431-437. doi: 10.1016/j.asjsur.2017.06.002
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.