Nifedipine Gel with Lidocaine in the Treatment of Anal Fissure in Children: A Pilot Study and Review of the Literature

Klin, Baruch; Abu-Kishk, Ibrahim; Efrati, Yigal; Lotan, Gad

doi:10.5772/33713

Cited by 4 publications

(7 citation statements)

References 59 publications

(47 reference statements)

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“…This was confirmed by other studies in which posterior anal fissure were more common than anterior fissure. 3,9,10 3,10 In our study relief in pain between group A and B was statistically significant (P 0.006). In a study conducted by Pardan at el reported 76%% good to excellent symptomatic relief with DTZ and 52% with GTN.…”

Section: Discussionsupporting

confidence: 55%

“…14 One pilot study was conducted in Israel in which combination of calcium channel blocker (nifedipine) with lignocaine was used to treat anal fissure in children. 10 In our study the incidence of AAF was higher in male children (63%) than female (37%) in both groups. Male to female ratio was 1.7: 1.…”

Section: Discussionsupporting

confidence: 44%

“…In other studies females were slightly more than males. 3,10 In the study by Cevik et al the reported incidence of AF more in female was 52.7%. 3 Mean age of children in our study was 4.72 ± 2.48 years in group A and 4.67 ±2.89 years in group B, while in a study conducted by Cevik at el the mean age was 2.5 years in diltiazem group and 2 years in GTN group.…”

Section: Discussionmentioning

confidence: 98%

“…3,6,7,8,9 Klin et al used Nifedipine (which is a calcium channel blocker) with lignocaine and anal fissure completely healed in 92.9% of their patients. 10 Surgical treatment options include dilatation of internal anal sphincter, fissurectomy and lateral internal sphincterotomy (LIS), but these may cause incontinence of stool . 5 It was observed by Richard et al that internal sphincter spasm was the common finding in anal fissure.…”

Section: Introductionmentioning

confidence: 99%

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Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

et al. 2020

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Introduction: Anal fissure is a common problem in children, the exact etiology of which is unknown and it mostly presents with painful defecation and bleeding per rectum. The standard treatment of anal fissure is lateral internal sphincterotomy but due to risk of fecal incontinence chemical sphincterotomy is used as alternative to surgical sphincterotomy. Aims & Objectives: To compare the effectiveness of topical diltiazem and lignocaine with glyceryl trinitrate and lignocaine in relieving of symptoms and healing of acute anal fissure in children. Place and duration of study: This study was conducted in the Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore & Department of Paediatric Surgery, Fatima Memorial Hospital, Lahore from September 2017 to September 2018. Material & Methods: Total 228 children were enrolled in the study and randomly divided in group A and B, 114 children in each group. Group A received topical 2% diltiazem cream and 2% lignocaine gel, while group B received topical 0.2% glyceryl trinitrate and 2% lignocaine gel, applied locally, twice daily. Results: There were 78(68.4%) male children in group A and 66(57.9%) in group B. All patients completed 6 week treatment course. The symptoms and condition of the anal fissure were evaluated before start of treatment and at subsequent follow up periods. In group A 55 (48.2%) cases completely healed by second week, while in group B, 33 (28.9%) cases healed. The number of completely healed cases at 4 weeks follow up in group A and group B were 91 (79.8%) and 69(60.5%) respectively, while at week 6 follow up this rate was 95 (83.3%) and 73 (64.0%) respectively. Symptomatic relief in painful defecation observed in group A and group B was 74(64.9%) and 55(48.2%) at week 2, 95(83.3%) and 74(64.9%) at week 4 while 95(83.3%) and 77(67.5%) at week 6 in two groups respectively. Conclusion: Use of combination of topical diltiazem and lignocaine for the treatment of acute anal fissure in paediatric population is preferred over combination of glyceryl trinitrate and lignocaine.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

et al. 2020

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“…Anal pain was relieved early in Group B (lignocaine–nifedipine ointment) as compared to Group A ( Yashtimadhu Ghrita ) as lignocaine is one of the topical anesthetic. [ 15 ] There is no statistically significant difference in number of days required for healing of ulcer in ano ( P value > 0.9999). In Group A, anal fissure healed earlier than Group B due to the trial drug ( Yashtimadhu Ghrita ) had potential to heal the ulcer.…”

Section: Discussionmentioning

confidence: 98%

A comparative clinical study of Yashtimadhu Ghrita and lignocaine-nifedipine ointment in the management of Parikartika (acute fissure-in-ano)

Patel

Dudhamal

2017

AYU

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Background:Parikartika is a common painful condition among anorectal diseases which resembles with fissure-in-ano. In the present era, due to changing lifestyle such as sedentary work pattern, increased stress, improper dietary and sleep habits, various lifestyle disorders are increasing continuously.Aim and Objective:The aim is to assess the effect of Yashtimadhu Ghrita in comparison with lignocaine–nifedipine ointment in the management of Parikartika (Acute fissure-in-ano).Materials and Methods:A total of 36 patients of acute fissure-in-ano were selected and randomly allocated into two groups (18 in each group). In Group A (n = 18), local application of Yashtimadhu Ghrita in fissure bed (Parikartika) twice a day after sitz bath for 4 weeks was given. In Group B (n = 18), local application of lignocaine–nifedipine ointment in fissure bed (Parikartika) twice a day after sitz bath for 4 weeks was given.Results:Patients of Group A (Yashtimadhu Ghrita) taken more time than the patients of Group B (lignocaine–nifedipine ointment) to get relief from pain in ano. Ulcer in ano healed earlier in patients of Group A (Yashtimadhu Ghrita) in comparison with patients treated with lignocaine–nifedipine ointment application. Patients of both groups have taken similar time to get relieved from bleeding PR. Complete remission of symptoms of Parikartika was more in patients treated with Yashtimadhu Ghrita than lignocaine–nifedipine ointment.Conclusion:Both the interventions Yashtimadhu Ghrita and lignocaine–nifedipine ointment are equally effective in symptomatic relief in Parikartika (acute fissure-in-ano).

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The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure

Brillantino,

Renzi,

Talento

et al. 2023

Preprint

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Introduction. The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature. Methods. A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology. Conclusions. In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (pneumatic anal dilatation, lateral internal sphincterotomy, fissurectomy with ano-cutaneous flap), may be guided by endoanal ultrasound and anal manometry findings.

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Nifedipine Gel with Lidocaine in the Treatment of Anal Fissure in Children: A Pilot Study and Review of the Literature

Cited by 4 publications

References 59 publications

Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

A comparative clinical study of Yashtimadhu Ghrita and lignocaine-nifedipine ointment in the management of Parikartika (acute fissure-in-ano)

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure

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