Meta-analysis of the use of glyceryl trinitrate ointment after haemorrhoidectomy as an analgesic and in promoting wound healing

Ratnasingham, Kumaran; Uzzaman, Mohammed Mohsin; Andreani, Stefano; Light, Duncan; Patel, Bharat

doi:10.1016/j.ijsu.2010.04.012

Cited by 54 publications

(41 citation statements)

References 29 publications

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“…There are several forms of nitrates such as Nitroderm bands used after haemorrhoidectomy to reduce the IAS spasm; however, the ointment is the most commonly available and used form. Ratnasingham et al in their meta-analysis showed that the post-hemorrhoidectomy use of 0.2% GTN ointment was statistically significant in reducing post-operative pain on days 3 and 7, but not statistically significant in reducing pain on post-operative day 1, probably because the major contributor of pain in the early period post-operatively is due to the surgical trauma [10]. In our study, 0.4 % GTN ointment showed a significantly effect on post-operative pain reduction during the first week after surgery (4.1±1.8 vs 7.5±1.4, p<0.0001, expressed as mean VAS score).…”

Section: Discussionmentioning

confidence: 99%

“…In the meta-analysis of Ratnasingham et al [10], on three studies, it has been shown that application of 0.2 % GTN ointment is associated with a significantly improved rate of wound healing at 3 weeks compared to matched placebo controls. A theory is that GTN may works in the same manner as in anal fissures, increasing the anodermal blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…As a matter of fact a recent meta-analysis indicates that this treatment appears a valid post-operative pain defender, although the authors conclude that inadequate availability of studies, which means a low number of patients involved in the meta-analysis, is an objective limitation [10].…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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

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“…Topical diltiazem showed a marginal benefit in reducing pain after surgery [25][26][27]. Glyceryl trinitrate ointment improved wound healing and reduced postoperative pain [28]. A recent randomized trial confirmed these results [29].…”

Section: Complicationsmentioning

confidence: 96%

Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

Picchio¹,

Greco²,

Filippo

et al. 2014

Indian J Surg

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Surgical therapy guaranties satisfactory results, which are significantly better than those obtained with conservative therapies, especially for Grade III and IV hemorrhoids. In this review, we present and discuss the results of the most diffuse surgical techniques for hemorrhoids. Traditional surgery for hemorrhoids aims to remove the hemorrhoids, with closure (Fergusson's technique) or without closure (Milligan-Morgan procedure) of the ensuing defect. This traditional approach is effective, but causes a significant postoperative pain because of wide external wounds in the innervated perianal skin. Stapled hemorrhoidopexy, proposed by Longo, has gained a vast acceptance because of less postoperative pain and faster return to normal activities. In the recent literature, a significant incidence of recurrence after stapled hemorrhoidopexy was reported, when compared with conventional hemorrhoidectomy. Double stapler hemorrhoidopexy may be an alternative to simple stapled hemorrhoidopexy to reduce the recurrence in advanced hemorrhoidal prolapse. Transanal hemorrhoidal deartertialization was showed to be as effective as stapled hemorrhoidopexy in terms of treatment success, complications, and incidence recurrence. However, further high-quality trials are recommended to assess the efficacy and safety of this technique.

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“…17 Research has also shown that GTN, as well as other anal spasmolytic agents, are helpful in reducing postoperative pain and healing time after open hemorrhoidectomy. [19][20][21] However, this benefit has not been explored in patients after stapled hemorrhoidectomy. The aim of this study was to conduct a randomized controlled trial comparing pain after stapled hemorrhoidectomy in patients with topical GTN and without (control patients) postoperatively.…”

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confidence: 99%

Glyceryl Trinitrate Ointment Did Not Reduce Pain After Stapled Hemorrhoidectomy: A Randomized Controlled Trial

Cross

Bartlett

Mushaya

et al. 2012

International Surgery

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Medications, including topical 0.2% glyceryl trinitrate (GTN), can reduce anal spasm and pain after excisional hemorrhoidectomy. GTN after stapled hemorrhoidopexy was compared with routine postoperative management. Patients with symptomatic grade 3/4 hemorrhoids were recruited. After stapled hemorrhoidopexy, residual perianal skin tags were excised as appropriate. Those requiring double purse-string mucosectomy were excluded. Postoperative pain, pain duration, and complications were assessed. One hundred ten patients (74 men; mean age 50.6 years) were enrolled in the control group and 100 patients (57 men; mean age 49.8 years) in the GTN group. Maximum pain was higher in the GTN group (P = 0.015). There were no differences between the two groups in residual perianal skin tags requiring excision, postoperative complications, recurrence rates, follow-up period, average pain, duration of pain, or satisfaction scores. Sixteen GTN patients were noncompliant due to side effects. None had persistent perianal skin tags. GTN did not reduce postoperative pain after stapled hemorrhoidectomy.

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Meta-analysis of the use of glyceryl trinitrate ointment after haemorrhoidectomy as an analgesic and in promoting wound healing

Abstract: This meta-analysis has shown that GTN ointment used post-haemorrhoidectomy has a significant analgesic effect in the intermediate time period (ie. Days 3-7). It also significantly improved wound healing at 3 weeks.

Cited by 54 publications

References 29 publications

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

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

Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

Glyceryl Trinitrate Ointment Did Not Reduce Pain After Stapled Hemorrhoidectomy: A Randomized Controlled Trial

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