Year 2015 / Volume 107 / Number 11
Original
Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial

681-685

DOI: 10.17235/reed.2015.3926/2015

Sergio Solorio-López, Ulises Rodrigo Palomares-Chacón, Jesús Enrique Guerrero-Tarín, Alejandro González-Ojeda, José Antonio Cortés-Lares, Jorge Rendón-Félix, Jesús García-Rentería, Mariana Chávez-Tostado, Lizbeth Araceli Cuesta-Márquez, Marcela Salazar-Parra, Clotilde Fuentes Orozco,

Abstract
Introduction: Hemorrhoidal disease occurs in 50% of people aged > 40 years and is the most common reason for anorectal surgery. Pain is the main complication. Multiple topical and systemic drugs have been investigated for pain control, but there is no ideal treatment. Metronidazole has been shown to decrease postoperative pain but is not used widely. Objective: To evaluate the effect of oral metronidazole versus placebo and to assess postoperative pain following hemorrhoidectomy. Material and methods: Controlled clinical trial in adult patients who underwent elective hemorrhoidectomy for grade III/IV hemorrhoids. Patients were assigned to receive metronidazole (500 mg q8 h orally; study group, SG) or placebo (control group, CG) for 7 days after surgery. Pain was assessed using a visual analog scale after surgery. Analgesic administration (time and use of analgesics) and resumption of daily life activities were also assessed. Results: Forty-four patients were included, 22 in each group. Postoperative pain differed significantly between the SG and CG at 6 h (3.86 ± 0.56, 6.64 ± 1.49), 12 h (5.59 ± 1.33, 8.82 ± 0.79), 24 h (6.86 ± 1.49, 9.73 ± 0.45), day 4 (5.32 ± 2.10, 9.50 ± 0.59), day 7 (3.14 ± 1.03, 7.36 ± 1.39), and day 14 (2.14 ± 0.46, 5.45 ± 1.29). The first analgesia dose was required at 21.27 ± 5.47 h in the CG and 7.09 ± 2.36 h in the SG (p < 0.05), the time of analgesic use was 6.86 ± 1.61 days in the CG and 13.09 ± 2.48 days in the SG (p < 0.05), and resumption of daily activities occurred at 7.59 ± 1.56 days in the CG and 14.73 ± 3.76 days in the SG (p < 0.05). Conclusion: Oral administration of metronidazole is effective in pain management after hemorrhoidectomy.
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References
1) Rivadeneira DE, Steele SR, Ternent C, et al. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum 2011; 54: 1059-64. DOI: 10.1097/DCR.0b013e318225513d.
2) Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol 2012; 18: 2009-17. DOI: 10.3748/wjg.v18.i17.2009.
3) Wang ZG, Zhang Y, Zeng XD, et al. Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy. World J Gastroenterol 2015; 21: 2490-6. DOI: 10.3748/wjg.v21.i8.2490.
4) Riss S, Weiser FA, Schwameis K, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis 2012; 27: 215-20. 10.1007/s00384-011-1316-3.
5) Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ 2008; 336: 380-3. DOI: 10.1136/bmj.39465.674745.80.
6) Fox A, Tietze PH, Ramakrishnan K. Anorectal conditions: hemorrhoids. FP Essent 2014; 419: 11-9.
7) Wang JY, Lu CY, Tsai HL, et al. Randomized controlled trial of LigaSure with submucosal dissection versus Ferguson hemorrhoidectomy for prolapsed hemorrhoids. World J Surg 2006; 30: 462-6. DOI: 10.1007/s00268-005-0297-1.
8) 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 2013; 37: 2454-7. DOI: 10.1007/s00268-013-2124-4.
9) Thomson WH. The nature and cause of haemorrhoids. Proc R Soc Med 1975; 68: 574-5.
10) Gaj F, Trecca A. Hemorrhoids and rectal internal mucosal prolapse: one or two conditions? A national survey. Tech Coloproctol 2005; 9: 163-5. DOI: 10.1007/s10151-005-0219-0.
11) de Paula PR, Speranzini MB, Hamzagic HC, et al. Bacteriology of the anal wound after open hemorrhoidectomy. Qualitative and quantitative analysis. Dis Colon Rectum 1991; 34: 664-9.
12) Selvaggi F1, Pellino G, Sciaudone G, et al. Development and validation of a practical score to predict pain after excisional hemorrhoidectomy. Int J Colorectal Dis 2014; 29: 1401-10. DOI: 10.1007/s00384-014-1999-3.
13) Khanna R, Khanna S, Bhadani S, et al. Comparison of Ligasure Hemorrhoidectomy with Conventional Ferguson's Hemorrhoidectomy. Indian J Surg 2010; 72: 294-7. 10.1007/s12262-010-0192-3.
14) 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 2013; 37: 657-62. DOI: 10.1007/s00268-012-1895-3.
15) Rahimi M, Kazemeini AR, Pourtabatabaei N, et al. Comparison of topical anesthetic cream (EMLA) and diclofenac suppository for pain relief after hemorrhoidectomy: a randomized clinical trial. Surg Today 2012; 42: 1201-5. DOI: 10.1007/s00595-012-0222-9.
16) Rajabi M, Hosseinpour M, Jalalvand F, et al. Ischiorectal block with bupivacaine for post hemorrhoidectomy pain. Korean J Pain 2012; 25: 89-93. DOI: 10.3344/kjp.2012.25.2.89.
17) Perrotti P, Dominici P, Grossi E, et al. 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: 17-24.
18) Silverman R, Bendick P, Wasvary HJ. A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy. Dis Colon Rectum 2005; 48: 1913-6. DOI: 10.1007/s10350-005-0135-4.
19) Ba-bai-ke-re MM, Huang HG, Re WN, et al. How we can improve patients comfort after Milligan-Morgan open haemorrhoidectomy. World J Gastroenterol 2011; 17: 1448-56. DOI: 10.3748/wjg.v17.i11.1448.
20) Ala S, Saeedi M, Eshghi F, et al. Efficacy of 10% sucralfate ointment in the reduction of acute postoperative pain after open hemorrhoidectomy: a prospective, double-blind, randomized, placebo-controlled trial. World J Surg. 2013;37:233-8. DOI: 10.1007/s00268-012-1805-8.
21) Neshige S, Kanaya Y, Takeshima S, et al. Reversible changes on MR images in a patient with metronidazole-induced encephalopathy. Rinsho Shinkeigaku. 2015; 55: 174-7. DOI: 10.5692/clinicalneurol.55.174.
22) Huang H, Nord CE. Can metronidazole still be used for treatment of Clostridium difficile infections? Curr Infect Dis Rep. 2009: 11: 3-6. DOI: 10.1007/s11908-009-0001-y.
23) Goldberg ND, Vadlamudi A, Parrish N. Treatment of refractory Crohn's disease and pyoderma gangrenosum with a combination regimen of rifaximin, gentamicin and metronidazole. Case Rep Gastroenterol 2015; 9: 25-8. DOI: 10.1159/000369965.
24) Molina-Infante J1, Lucendo AJ, Angueira T, et al. Optimised empiric triple and concomitant therapy for Helicobacter pylori eradication in clinical practice: the OPTRICON study. Aliment Pharmacol Ther 2015; 41: 581-9. DOI: 10.1111/apt.13069.
25) Oshima T, Takesue Y, Ikeuchi H, et al. Preoperative oral antibiotics and intravenous antimicrobial prophylaxis reduce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA. Dos Colon Rectum 2013; 56: 1149-55. DOI: 10.1097/DCR.0b013e31829f71a0.
26) Kim H, Kim YW, Kim SR, et al. Metronidazole-induced encephalopathy in a patient with infectious colitis: a case report. J Med Case Re 2011; 14:63. DOI: 10.1186/1752-1947-5-63.
27) Carapeti EA, Kamm MA, McDonald PJ, et al. Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet 1998; 351: 169-72.
28) Balfour L, Stojkovic SG, Botterill ID, et al. A randomized, double-blind trial of the effect of metronidazole on pain after closed hemorrhoidectomy. Dis Colon Rectum 2002; 45: 1186-90.
29) Al-Mulhim AS, Ali AM, Al-Masuod N, et al. Post hemorrhoidectomy pain. A
randomized controlled trial. Saudi Med J. 2006;27:1538-41.
30) Nicholson TJ, Armstrong D. Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing. Dis Colon Rectum 2004; 47: 711-6. DOI: 10.1007/s10350-003-0129-z.
31) Ala S, Saeedi M, Eshghi F, et al. Topical metronidazole can reduce pain after surgery and pain on defecation in postoperative hemorrhoidectomy. Dis Colon Rectum 2008; 51: 235-8. DOI: 10.1007/s10350-007-9174-3.
32) Khan KI, Akmal M, Waqas A, et al. Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy - a randomized control trial. Int J Surg. 2014;12:868-71. DOI: 10.1016/j.ijsu.2014.06.005.
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Solorio-López S, Palomares-Chacón U, Guerrero-Tarín J, González-Ojeda A, Cortés-Lares J, Rendón-Félix J, et all. Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial. 3926/2015


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Publication history

Received: 14/07/2015

Accepted: 13/08/2015

Online First: 15/09/2015

Published: 30/10/2015

Article revision time: 27 days

Article Online First time: 63 days

Article editing time: 108 days


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