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

Ala, Shahram; Eshghi, F; Enayatifard, Reza; Fazel, Payam; Rezaei, Banafsheh; Hadianamrei, Roja

doi:10.1007/s00268-012-1895-3

Cited by 27 publications

(25 citation statements)

References 47 publications

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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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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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“…A number of ways have been attempted to relieve pain after a hemorrhoidectomy. For example, Ala et al [ 20 ] reported that cholestyramine ointment was effective against postoperative pain after a hemorrhoidectomy; the ointment group experienced less pain 12 and 48 hours after surgery than the control group did, and their pain completely disappeared 2 weeks later. Other effective treatments for the relief of postoperative pain, including preoperative lactulose [ 21 ], postoperative metronidazole [ 22 ], a left lateral anal sphincterectomy with hemorrhoidectomy [ 5 23 ], and botulinum injections, have been reported [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of a Hemorrhoidectomy With Ultrasonic Scalpel Versus a Conventional Hemorrhoidectomy

et al. 2016

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PurposeA variety of instruments, including circular staplers, ultrasonic scalpels, lasers, and bipolar electrothermal devices, are currently used when performing a hemorrhoidectomy. This study compared outcomes between hemorrhoidectomies performed with an ultrasonic scalpel and conventional methods.MethodsThe study was a randomized prospective review of data available between May 2013 and December 2013, involving 50 patients who had undergone a hemorrhoidectomy for grade III or IV internal hemorrhoids. The hemorrhoidal pedicle was coagulated with an ultrasonic device in the ultrasonic scalpel group (n = 25) and sutured with 3-0 vicryl material after excision in the conventional method group (n = 25).ResultsThe patients' demographics, clinical characteristics, and lengths of hospital stay were similar in both groups. The mean ages of the conventional and the ultrasonic scalpel groups were, respectively, 20.8 ± 1.6 and 22.4 ± 5.0 years (P = 0.240). In comparison with the conventional method group, the ultrasonic scalpel group had a shorter operation time (P < 0.005), less postoperative pain on the visual analogue scale score (for example, P = 0.211 on postoperative day 1), and less postoperative bleeding (P = 0.034). No significant differences in postoperative complications were observed between the 2 groups.ConclusionA hemorrhoidectomy using an ultrasonic scalpel is an effective and safe procedure. The ultrasonic scalpel reduces the operation time, the postoperative blood loss, and the postoperative pain. Long-term follow-up with larger-scale studies is required to evaluate normal activity after a hemorrhoidectomy performed with an ultrasonic scalpel.

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“…Although therapeutic options of pruritus are available, the lack of well-conducted, randomized, controlled studies is an obstacle for the development of an effective and uniform treatment protocol. Cholestyramine is the most recommended first line therapy for pruritus[ 71 ], while rifampicin, opiate antagonists and sertraline have been utilized as second-, third-, and fourth-line therapies, respectively[ 72 , 73 ].…”

Section: Therapeutic Strategies Of Hcv-associated Pruritusmentioning

confidence: 99%

Hepatitis C virus-associated pruritus: Etiopathogenesis and therapeutic strategies

Alhmada¹,

Selimović²,

Murad³

et al. 2017

WJG

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In addition to its contributing role in the development of chronic liver diseases, chronic hepatitis C virus (HCV) infection is associated with extrahepatic manifestations, particularly, cutaneous-based disorders including those with pruritus as a symptom. Pruritus is frequently associated with the development of chronic liver diseases such as cholestasis and chronic viral infection, and the accumulation of bile acids in patients’ sera and tissues as a consequence of liver damage is considered the main cause of pruritus. In addition to their role in dietary lipid absorption, bile acids can trigger the activation of specific receptors, such as the G protein-coupled bile acid receptor (GPBA/ TGR5). These types of receptors are known to play a crucial role in the modulation of the systemic actions of bile acids. TGR5 expression in primary sensory neurons triggers the activation of the transient receptor potential vanilloid 1 (TRPV1) leading to the induction of pruritus by an unknown mechanism. Although the pathologic phenomenon of pruritus is common, there is no uniformly effective therapy available. Understanding the mechanisms regulating the occurrence of pruritus together with the conduction of large-scale clinical and evidence-based studies, may help to create a standard treatment protocol. This review focuses on the etiopathogenesis and treatment strategies of pruritus associated with chronic HCV infection.

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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

Abstract: Compared with placebo, cholestyramine ointment (15%) reduced postoperative pain at rest and on defecation, and consequently lowered the analgesic requirement after open hemorrhoidectomy.

Cited by 27 publications

References 47 publications

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

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

Comparison of a Hemorrhoidectomy With Ultrasonic Scalpel Versus a Conventional Hemorrhoidectomy

Hepatitis C virus-associated pruritus: Etiopathogenesis and therapeutic strategies

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