Benefits of flavonoid and metronidazole use after excisional hemorrhoidectomy: a randomized double-blind clinical trial

Rabelo, Fernanda Elias Ferreira; Lacerda‐Filho, Antônio; Mansur, Eliane Sander; Oliveira, Fábio Henrique de; Queiroz, Fábio Lopes de; Neto, Paulo Rocha França; Misson, N

doi:10.1007/s10151-021-02465-0

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…It is worth noting that these recommendations are mostly derived from individual interventional studies rather than multimodal studies. Interesting, recent evidence has supported a multimodal approach to post-hemorrhoidectomy pain, e.g., a combination of flavonoids and oral metronidazole had a greater degree of pain reduction after hemorrhoidectomy than either single medication [ 93 ]. Moreover, increased adherence to guideline recommendations or surgical care bundles was associated with better short-term and long-term surgical outcomes [ 94 , 95 ].…”

Section: Resultsmentioning

confidence: 99%

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Lohsiriwat

Jitmungngan

2022

Medicina

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Background and Objectives: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain. Materials and Methods: The databases of Ovid MEDLINE, PubMed and EMBASE were systematically searched for randomized controlled trails (published in English language with full-text from 1981 to 30 September 2021) to include comparative studies examining post-hemorrhoidectomy pain as their primary outcomes between an intervention and another intervention (or a sham or placebo). Results:Some 157 studies were included in this review with additional information from 15 meta-analyses. Fundamentally, strategies to reduce post-hemorrhoidectomy pain were categorized into four groups: anesthetic methods, surgical techniques, intraoperative adjuncts, and postoperative interventions. In brief, local anesthesia-alone or combined with intravenous sedation was the most effective anesthetic method for excisional hemorrhoidectomy. Regarding surgical techniques, closed (Ferguson) hemorrhoidectomy performed with a vascular sealing device or an ultrasonic scalpel was recommended. Lateral internal anal sphincterotomy may be performed as a surgical adjunct to reduce post-hemorrhoidectomy pain, although it increased risks of anal incontinence. Chemical sphincterotomy (botulinum toxin, topical calcium channel blockers, and topical glyceryl trinitrate) was also efficacious in reducing postoperative pain. So were other topical agents such as anesthetic cream, 10% metronidazole ointment, and 10% sucralfate ointment. Postoperative administration of oral metronidazole, flavonoids, and laxatives was associated with a significant reduction in post-hemorrhoidectomy pain. Conclusions: This systematic review comprehensively covers evidence-based strategies to reduce pain after excisional hemorrhoidectomy. Areas for future research on this topic are also addressed at the end of this article.

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Section: Resultsmentioning

confidence: 99%

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Lohsiriwat

Jitmungngan

2022

Medicina

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“…Extensive anoderm excision might cause anal spasm, which subsequently cause pain [ 11 ]. There were several published methods for reducing pain after hemorrhoidectomy [ 1 , 12 ]. Previous study used flavonoids and metronidazole, which resulted in a reduction of pain after excisional hemorrhoidectomy [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…There were several published methods for reducing pain after hemorrhoidectomy [ 1 , 12 ]. Previous study used flavonoids and metronidazole, which resulted in a reduction of pain after excisional hemorrhoidectomy [ 12 ]. Opioid analgesics were also used to reduce pain after hemorrhoidectomy [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of anal dilatation versus no dilatation with a standardized dilator in reducing pain after hemorrhoidectomy: a randomized control trial

et al. 2022

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Background Post-operative pain is the main problem of hemorrhoidectomy. An adequate pain management can promote early mobilization, fast recovery, and reduce hospitalization costs. This study aimed to investigate the role of preoperative anal dilatation using a standardized anal dilator in reducing post-operative pain. Method This study was conducted using randomized prospective trial with a total of 40 subjects, who were divided into 2 groups. The first group received preoperative anal dilatation using a 33 mm anal dilator for 20 min, while the second group did not. The post-operative anal pain, edema, bleeding, and incontinence were observed in the first, second, and seventh day. Result The post-operative pain was significantly lower in the preoperative anal dilatation group for all days of observation (p < 0.05). The difference of post-operative bleeding and edema between groups were not significant. Fecal incontinence was initially significantly higher in the preoperative anal dilatation group, but the difference was insignificant at the seventh day (p = 0.500). Conclusion Preoperative anal dilatation significantly reduced post-operative pain. The side effect of fecal incontinence was only temporary until the seventh day after surgery. Trial Registration This trial was registered on Thai Clinical Trials Registry (TCTR) with TCTR identification number TCTR20220314002, on 14/03/2022 (retrospectively registered).

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“…This procedure provides the lowest percentages of recurrences but does not eliminate the usual postoperative complications: pain and bleeding. Many attempts are done to minimize PO pain: metronidazole, mesoglycan, or diosmine by mouth and, to reduce the sphincteric spasm, topical use of 2% diltiazem or GTN ointment, botulin toxin injection, and preventive lateral sphincterotomy (10). In a recent trial flavonoid associated with metronidazole seems to reduce pain, and bleeding, after excisional hemorrhoidectomy (11).…”

Section: Discussionmentioning

confidence: 99%

Self-Mechanical Anal Dilatation: A Simple Trick to Minimize Postoperative Pain and Stenosis Following Hemorrhoidectomy With Radiofrequency

Eberspacher

Mascagni

Zeri³

et al. 2021

Front. Surg.

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Aim: Hemorrhoidectomy is still the most effective surgical treatment for hemorrhoidal disease, but it is, however, associated with complications such as pain and stenosis. We proposed to break the “vicious circle” of “pain–sphincteric spasm–stenosis–pain” with the postoperative use of self-mechanical anal dilation.Methods: We retrospectively analyzed patients with hemorrhoidal disease presenting with a minimum of piles of three quadrants, treated with radiofrequency hemorrhoidectomy between January 2018 and December 2019. All the patients that at 3 weeks presented sphincteric spasms with painful defecation, were considered. Thirty-nine patients performed the cycle of self-mechanical anal dilation (Group A). This group was 1:1 matched with homogeneous patients from our historical cohort of patients (Group B). The primary endpoint was the pain evaluation, secondary endpoints: WCS, overall satisfaction of the patient, anal sphincter spasm, scarring, and the incidence of postoperative stenosis.Results: In Group A mean VAS was 3.25 after 14 days of application and 1.15 at the end of the application. In Group B mean VAS was persistently higher, with a mean VAS of 5 (p = 0.000002) and 3.38 (p = 0.0000000000009). In Group A we observed an improvement of symptoms at the end, with a good overall satisfaction (Group A 7.4 vs. Group B 5.9; p = 0.0000007) and a better mean WCS (Group A WCS 2.8 vs. Group B WCS 4.18; p = 0.0001). Stenosis was observed in 3/39 patients of Group B (7.7%).Conclusions: Self-mechanical anal dilation improves the pain in the late postoperative course, minimizing the risk of anal stenosis.

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Benefits of flavonoid and metronidazole use after excisional hemorrhoidectomy: a randomized double-blind clinical trial

Cited by 9 publications

References 16 publications

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Comparison of anal dilatation versus no dilatation with a standardized dilator in reducing pain after hemorrhoidectomy: a randomized control trial

Self-Mechanical Anal Dilatation: A Simple Trick to Minimize Postoperative Pain and Stenosis Following Hemorrhoidectomy With Radiofrequency

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