Botulinum Toxin (Botox®) Reduces Pain After Hemorrhoidectomy

Davies, Justin; Duffy, David M.; Boyt, Nicholas; Aghahoseini, Assad; Alexander, David N.; Leveson, Stephen H.

doi:10.1007/s10350-004-7286-6

Cited by 88 publications

(63 citation statements)

References 26 publications

(36 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…‘Chemical sphincterotomy’ by the application of topical 0.2% GTN post-operatively appears to confer no benefit, although it may effect more rapid wound healing [47]. Recently, botulinum toxin has been shown to improve pain in the first post-operative week [48], but the sample size was small and the difference to placebo marginal.…”

Section: Operative Treatmentsmentioning

confidence: 99%

The Surgical Management of Haemorrhoids – A Review

Hardy¹,

Chan²,

Cohen³

2005

Dig Surg

View full text Add to dashboard Cite

A number of new surgical treatments have led to a reappraisal of haemorrhoid disease over the last few decades. Despite a range of treatment modalities, the options are limited in their effectiveness and can lead to a number of complications. An inadequate classification system based on appearance rather than symptoms makes the choice of appropriate therapy difficult. More recent techniques have led to a move away from surgical excision. However, further research is required to establish their precise indications and long-term efficacy.

show abstract

Section: Operative Treatmentsmentioning

confidence: 99%

The Surgical Management of Haemorrhoids – A Review

Hardy¹,

Chan²,

Cohen³

2005

Dig Surg

View full text Add to dashboard Cite

show abstract

“…To overcome the irreversibility of lateral sphincterotomy and the effects on incontinence, botulinum toxin injection (Botox ® , Allergan Ltd, Bucks, UK) has also been attempted after haemorrhoidectomy. Davies et al [16] reported lower pain scores in patients who received botulinum toxin, which only became significant by day 6. Patti et al [17] similarly found a reduction in post-operative pain scores, which were significant from post-operative day 1 in patients given Botox injection.…”

Section: Discussionmentioning

confidence: 97%

Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study

Franceschilli

D’Ugo

Luca

et al. 2012

Int J Colorectal Dis

View full text Add to dashboard Cite

Introduction Conventional haemorrhoidectomy (CH) is well known to cause significant post-operative pain and delayed return to daily activities. Both surgical wounds and sphincterial apparatus spasms are likely responsible for the pain. In this study, we evaluated the role of glyceryl trinitrate ointment (GTN) in reducing post-operative pain, ameliorating wound healing and recovery after CH. Patients and methods Between 01/08 and 12/11, 203 patients with symptomatic haemorrhoids were enrolled in the study and received (103 patients) or not (100 patients) 0.4 % GTN ointment for 6 weeks after surgery. Pain was assessed using a 10-cm linear visual analogue scale (VAS). Data on postoperative pain, wound secretion and bleeding, return to normal activities and complications were recorded. Data were analysed using Fisher's exact and Mann-Whitney tests. Results GTN-treated group experienced significantly less pain during the first week after surgery (p< 0.0001). This difference was more evident starting from postoperative day 4 (p<0.0001). A significant higher percentage of untreated patients experienced severe pain (mean VAS score>7) (10 % vs 31 %). There were significant differences in terms of secretion time (p00.0052) and bleeding time (p00.02) in favor of GTN. In addition, the duration of itching was less in the GTN group (p00.0145). Patients treated with GTN were able to an early return to daily activities compared to untreated (p < 0.0001). Fifteen GTN-treated patients (14.6 %) discontinued the application because of local discomfort and headache. Conclusions GTN ointment enhances significantly postoperative recovery, reducing pain in terms of duration and intensity. This effect might be secondary to a faster wound healing expressed by reduced secretion, bleeding and itching time.

show abstract

“…Various methods to reduce postoperative pain in this procedure have included electrosurgical devices, such as diathermy, ultrasonic dissection, Ligasure Ò , and stapled hemorrhoidopexy [12], which diminish thermal injury to the subjacent tissue and reduce sphincter muscle [13], and the use of different forms of analgesia and anesthesia [14,15]. Numerous other attempts to control posthemorrhoidectomy pain have been reported, including the use of botulin toxin [16] and nitrates [17] to reduce internal sphincter spasm, metronidazole [18] to avoid bacterial fibrinolysis, or sucralfate [19] utilizing a mechanical barrier to favor wound epithelization or to improve pain control and patient comfort in the immediate postoperative course with infiltration of long-acting local anesthetic, pre-emptively or postoperatively [20,21]. In contrast to the preceding, our strategy was based on the local application of very low doses of opioids in the embedded cotton gauze set in the anus after surgery, thereby providing for a direct action on the drug receptor.…”

Section: Discussionmentioning

confidence: 98%