Efficacy of 10 % Sucralfate Ointment in the Reduction of Acute Postoperative Pain After Open Hemorrhoidectomy: A Prospective, Double‐Blind, Randomized, Placebo‐Controlled Trial

Ala, Shahram; Saeedi, Majid; Eshghi, F; Rafati, Mohamadreza; Hejazi, Vahid; Hadianamrei, Roja

doi:10.1007/s00268-012-1805-8

Cited by 27 publications

(26 citation statements)

References 57 publications

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“…Ala S et al used topical metronidazole 10% in post hemorrhoidectomy patients that resulted in significantly reduced pain on day 07 and 14 ( p≤0.04 ) as compared to placebo. 6 Similar results obtained by Gonzalez A et al in 2015 where patients experienced significantly less post-operative pain. 5 Pourghassem J et al in 2012 studied 40 patients randomly distributed between topical metronidazole and placebo, showed that patients on topical metronidazole experienced less pain, they required few analgesics.…”

Section: Discussionsupporting

confidence: 76%

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Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial

Abbas

Raza

Muhammad³

et al. 2020

Pak J Med Sci

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Background and Objectives: Milligan Morgan Hemorrhoidectomy is one of the most commonly performed surgeries. Post-operative pain is the major cause of morbidity in post hemorrhoidectomy patients. Metronidazole has an established role in relieving post hemorrhoidectomy pain. The objective was to evaluate the pain score by using topical and oral metronidazole in post Milligan Morgan hemorrhoidectomy patients. Methods: A prospective randomized controlled trail was done in surgical departments of Akbar Niazi Teaching Hospital, Islamabad. A total of 166 consecutive patients with 3rd and 4th degree hemorrhoids were presenting in surgical OPD and who underwent Milligan Morgan hemorrhoidectomy between July 2018 and December 2018 were included in the study. Patients allocated in two groups, Group-A received topical metronidazole 10% post hemorrhoidectomy for seven days and Group-B were given oral metronidazole 400mg for 07 days. Analgesics were given on patient’s requirement. Patients post hemorrhoidectomy pain was recorded by using VSA scale at baseline (1st day) and on 7th post-operative day. Data analysis was done by using SPSS 21. Pain calculated by compared in terms of mean, standard deviation between groups and independent sample T test was used. Association between demographic details like gender and ages of the patients with pain scale on 7th day was measured and chi-square distribution was used. Results: Total 166 patients were included in this study. The mean ages of the patients were 44.07±10.62 years with minimum 20 and maximum 60 years. Out of 166 patients, female were 55 (33.1%) and male were 111 (66.9%). Results showed significantly lower pain in patients using topical metronidazole as compared to oral metronidazole (p=0.001). Association of pain with respect to ages was insignificant (p=0.202) whereas between genders inside the groups showed significant difference (p=0.028). Conclusion: These results showed that topical metronidazole significantly reduces pain in post hemorrhoidectomy patients as compared to oral metronidazole overall and even when data stratified among age, gender and type of hemorrhoids. doi: https://doi.org/10.12669/pjms.36.5.1796 How to cite this:Abbas ST, Raza A, Chaudhry I, Hameed T, Hasham N, Arshad N. Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.1796 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionsupporting

confidence: 76%

“… 3 Various remedies have been suggested to alleviate the post-operative pain like GTN 0.2%, topical NSAIDS, Ca channel blockers and metronidazole. 4 Studies show that metronidazole in both forms (topical and oral) significantly reduces the post-operative pain ( p0.004, p0.0011 ) 5 , 6 and improves the wound healing compared to placebo.…”

Section: Introductionmentioning

confidence: 99%

Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial

Abbas

Raza

Muhammad³

et al. 2020

Pak J Med Sci

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“…Several strategies have been proposed: acupuncture [7], creams or gels with several agents (nitrites, anesthetics, calcium antagonists, sucralfate, metronidazole, salsobromoiodic, cholestyramine) for topical application [8], [9], [10], [11], [12], [13], [14], [15], nonsteroidal anti-inflammatory suppositories [11], local infiltration with botulinum toxin [16], or local anesthetic agents [5], [6], [17] or even ambulatory PCA (patient controlled analgesia) pumps [18].…”

Section: Discussionmentioning

confidence: 99%

Is the severe pain after Milligan-Morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? A case series of 117 consecutive patients

Medina-Gallardo¹,

Curbelo-Peña²,

Castro³

et al. 2017

International Journal of Surgery Case Reports

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HighlightsPostoperative pain in the Milligan-Morgan hemorrhoidectomy remains a reality in a large number of centers, where it is practiced routinely, without analgesic specific strategies. It involves a not inconsiderable number of days of hospitalization and a high utilization rate of opiates, comparable to other abdominal major surgeries as reported by the literature.In this sense we are proposing a new strategy for better control of post-hemorrhoidectomy pain.

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“…13 In another work by Ala et al, topical sucralfate did decreased posthemorrhoidectomy pain in the first 24 h after surgery, by thorough revision of the methods and results of this study and Mirani study; we had found high cross matching between them which may raise doubts about plagiarism. 14 Sucralfate also had been tried in post anal fistulotomy wound and proved to be effective regarding pain control and wound healing. 15 Despite being inferior to sucralfate; local anesthetic lidocaine ointment did reduced pain intensity post hemorrhoidectomy when compared to placebo group.…”

Section: Discussionmentioning

confidence: 99%

Double blinded randomized placebo-controlled comparative study between sucralfate ointment and lidocaine ointment after Milligan Morgan hemorrhoidectomy

Alkhateep

Fareed

2017

Int Surg J

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Background: Post haemorrhoidectomy pain and delayed wound healing are the most annoying drawbacks to the patients and the surgeons. Topical application of sucralfate or lidocaine may help in reducing postoperative pain and promoting wound healing after Milligan Morgan hemorrhoidectomy.Methods: This study was designed as a single-center double blinded randomized placebo controlled trial at the Department of general Surgery Menoufia University, immediately after Milligan Morgan Hemorrhoidectomy, a total of 150 patients were randomly assigned to receive either 10% Sucralfate ointment, 5% lidocaine ointment or placebo ointment (control group). The primary outcome measure was pain intensity measured by a visual analogue scale at different time points after hemorrhoidectomy and the secondary outcome measure was wound healing.Results: There was no significant difference in age, gender, and number of excised hemorrhoid piles between the two groups. At the 1st ,3rd and 7th days after surgery pain intensity was significantly lower in sucralfate group (4.18±0.82, 3.92±0.72, 3.56±0.67) when compared to lidocaine group (5.06±1.11, 4.70±0.84, 3.93±0.75) and placebo group (6.17±1.26, 5.42±0.98, 4.55±0.84). At the 21st and 28th days no significant difference in pain intensity between groups (p > 0.05) with better wound healing in sucralfate group (P<0.05).Conclusions: Sucralfate was able to reduce the acute postoperative pain and improve wound healing after hemorrhoidectomy, local anesthetic lidocaine could help in pain control but without effect on healing.

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Efficacy of 10 % Sucralfate Ointment in the Reduction of Acute Postoperative Pain After Open Hemorrhoidectomy: A Prospective, Double‐Blind, Randomized, Placebo‐Controlled Trial

Abstract: Sucralfate ointment reduced the acute postoperative pain after hemorrhoidectomy.

Cited by 27 publications

References 57 publications

Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial

Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial

Is the severe pain after Milligan-Morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? A case series of 117 consecutive patients

Double blinded randomized placebo-controlled comparative study between sucralfate ointment and lidocaine ointment after Milligan Morgan hemorrhoidectomy

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