Effect of Glyceryl Trinitrate Ointment on Pain Control After Hemorrhoidectomy: A Meta‐analysis of Randomized Controlled Trials

Liu, Jen Wei; Lin, Chao Chun; Kiu, Kee Thai; Wang, Chun Yu; Tam, Ka Wai

doi:10.1007/s00268-015-3344-6

Cited by 36 publications

(19 citation statements)

References 44 publications

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“…Glyceryl trinitrate is thought to effect a temporary ‘chemical sphincterotomy’ [ 48 ] and increase anodermal blood flow in the first 2 postoperative weeks following haemorrhoidectomy. It improves pain, healing [ 49 ] and resumption of daily activities at the expense of an increased incidence of headaches [ 50 ]. Similar results have also achieved with local calcium channel blockers [ 51 , 52 ], botulinum toxin A [ 53 ], and topical baclofen therapy [ 54 ].…”

Section: Third-degree Haemorrhoidsmentioning

confidence: 99%

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

Young

2020

Ann Coloproctol

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The treatment of haemorrhoids remains challenging: multiple treatment options supported by heterogeneous evidence are available, but patients rightly demand a tailored approach. Evidence for newer surgical techniques that promise to be less painful has been conflicting. We review the current evidence for management options in patients who present with varying haemorrhoidal grades. A review of the English literature was performed utilizing MEDLINE/PubMed, Embase, and Cochrane databases (31 May 2019). The search terms (haemorrhoid OR haemorrhoid OR haemorrhoids OR haemorrhoids OR “Hemorrhoid”[Mesh]) were used. First- and second-degree haemorrhoids continue to be managed conservatively. The easily repeatable and cost-efficient rubber band ligation is the preferred method to address minor haemorrhoids; long-term outcomes following injection sclerotherapy remain poor. Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence; nevertheless, posthaemorrhoidectomy pain is problematic. Stapled haemorrhoidopexy allows quicker recovery, albeit at the costs of higher recurrence rates and potentially serious complications. Transanal Haemorrhoidal Dearterialization has been promoted as nonexcisional and less invasive, but the recent HubBLe trial has questioned its overall place in haemorrhoid management. Novel “walk-in-walk-out” techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management. There are numerous treatment options for haemorrhoids, each with their own evidence-base. Newer techniques promise to be less painful, but recurrence rates remain an issue. The balance continues to be sought between long-term efficacy, minimisation of postoperative pain, and preservation of anorectal function.

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Section: Third-degree Haemorrhoidsmentioning

confidence: 99%

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

Young

2020

Ann Coloproctol

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“…Post‐operative anal spasm and hypertonia has been suggested to also be part of the pathogenesis of pain following haemorrhoidectomy . Surgical lateral internal sphincterotomy, as well as chemical sphincterotomy involving topical calcium channel blockers, GTN and botulinum toxin A injections have all been investigated with varying levels of efficacy. Multi‐modal regimens combining agents targeting each of the bacterial, inflammatory and hypertonicity pathways have not been studied together previously and serve as future topics of research.…”

Section: Resultsmentioning

confidence: 99%

Metronidazole following excisional haemorrhoidectomy: a systematic review and meta‐analysis

Xia

Manning

Barazanchi

et al. 2018

ANZ Journal of Surgery

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“…One contributory factor may be spasm of the internal anal sphincter (IAS), which is exposed and impinged after EH. [ 3 , 4 ] Therefore, different methods and techniques have been employed to overcome this inevitable problem.…”

Section: Introductionmentioning

confidence: 99%

Effect of lateral internal sphincterotomy in patients undergoing excisional hemorrhoidectomy

Wang

Lu²,

Yang³

et al. 2018

Medicine

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Background:Excisional hemorrhoidectomy (EH) is the major surgical option for high-grade symptomatic hemorrhoids, but it has some shortcomings, especially postoperative pain. This study was performed to assess the effect of lateral internal sphincterotomy (LIS) in patients undergoing excisional hemorrhoidectomy.Methods:A systematic literature search (Medline, Embase, Cochrane Library, Science Citation Index, Science Direct, Springer Link, Ovid Journals, and EBSCO) was performed to identify all eligible articles. Randomized controlled trials (RCTs) published until July 7, 2017 comparing EH combined with LIS (experimental group) with EH only (control group) were eligible for inclusion. The primary outcome of interest was postoperative pain.Results:Ten RCTs involving 1560 patients were identified for inclusion. The pooled analysis revealed that patients undergoing EH and LIS were associated with lower pain score [standardized mean difference (SMD), −0.75; 95% confidence interval (CI), −1.14 to −0.36; z = 3.76; P = .0002] and resting anal pressure [odds ratio (OR), −17.19; 95% CI, −25.66 to −8.72; z = 3.98; P < .0001], and lower incidence of anal stricture (OR, 0.12; 95% CI, 0.03–0.53; z = 2.85; P = .004). However, the differences of urinary retention, bleeding and length of hospital stay were similar between the 2 methods.Conclusion:Our meta-analysis suggests that LIS effectively relieves postoperative pain and reduces patient's postoperative analgesic requirements. LIS also reduces the incidence of anal stenosis but increases the incidence of fecal incontinence.

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Effect of Glyceryl Trinitrate Ointment on Pain Control After Hemorrhoidectomy: A Meta‐analysis of Randomized Controlled Trials

Abstract: Topical application of glyceryl trinitrate effectively relieves pain and promotes wound healing after hemorrhoidectomy; however, the substantial headache incidence may limit extensive application.

Cited by 36 publications

References 44 publications

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

Metronidazole following excisional haemorrhoidectomy: a systematic review and meta‐analysis

Effect of lateral internal sphincterotomy in patients undergoing excisional hemorrhoidectomy

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