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Abstract: Post Hemorrhoidectomy Pain
(Click here for the entire article) METHODS: A prospective, randomized trial was conducted to compare posthemorrhoidectomy pain and wound healing with use of topical metronidazole (10 percent) vs. placebo carrier, applied to the surgical site. Surgical indications included grade 3 or 4 internal or external hemorrhoidal disease, with or without a fissure-in-ano. Pain was assessed using a visual analog score (VAS) preoperatively and on postoperative days 1, 2, 7, 14, and 28. Twenty-four-hour narcotic use (hydrocodone 10 mg) was recorded on postoperative days 1, 2, 7, 14, and 28. Digital photographs of the surgical site were taken at 14 days postoperatively. The photographs were independently ranked by three blinded observers according to a) postoperative edema, b) primary vs. secondary healing, and c) overall wound healing. RESULTS: Twenty patients were
randomized in a prospective manner, ten to the topical 10
percent metronidazole group and ten to the placebo carrier
group. Patients in the topical metronidazole group experienced
significantly less postoperative pain at day 7 (VAS ± SEM, 3.4 ±
0.4 vs. 6.3 ± 0.5; P = 0.002) and day 14 (1.0 ± 0.4 vs. 3.2 ±
0.7, P = 0.02). There was no statistical difference in narcotic
analgesic requirements between groups. In the metronidazole
group, postoperative edema was ranked significantly lower (mean
score, 3.0 vs. 7.0, P < 0.01) and overall wound healing ranked
significantly better CONCLUSION: Topical 10 percent metronidazole significantly reduces posthemorrhoidectomy discomfort at days 7 and 14 postoperatively. Postoperative edema is reduced and overall healing is improved, compared with that of carrier controls.
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