Randomized, prospective, double-blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy

Wasvary, Harry; Hain, Jon; Mosed-Vogel, Michele; Bendick, Phil; Barkel, Donald; Klein, Steven N.

doi:10.1007/bf02234622

Cited by 81 publications

(68 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The exact aetiopathology of post-operative pain after haemorrhoidectomy has not been defined yet, although hypertonia of internal anal sphincter (IAS) is widely believed to be the major contributor. Another contributing factor may be the manipulation of the sensitive anoderm, which may activate the somatic pain receptors [4,6]. Eisenhammer was the first to propagate the idea that post-haemorrhoidectomy pain is due to the spasm of the internal sphincter and described that its division through one of the hemorrhoid wounds is certainly an effective way to lessen post-operative pain.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Although the spasm of the voluntary external sphincter may also play a role in generating pain, internal sphincter spasm is thought to be the major contributor [4,5]. During the past years, conservative and surgical solutions have been proposed to reduce this effect.…”

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…The local application medications [1][2][3] , administered on the muscle 4-7 or other site [8][9][10][11][12][13][14][15] , as well as the approved resources in the literature to treat or avoid pain [16][17][18] were not used for we wouldn´t have a variable that could interfere on the pain process.…”

Section: Discussionmentioning

confidence: 99%

“…Many surgical and anesthetic measures have been used to avoid or to lessen such. It is up to the anesthesiologist to adopt some measures recommending the use of certain medicaments [1][2][3][4][5][6][7][8][9][10] , preemptive analgesia [11][12][13][14][15] . Botulinic toxin injection can also be used in the internal sphincter 16 micronized fractions of flavonoids 17 and the transcutaneous electrical stimulation 18 .…”

Section: Introductionmentioning

confidence: 99%

Epidural anesthesia using a 0,75% ropivacaine and subarachnoid anesthesia with a 0,5% bupivacaine associated or not with clonidine in hemorroidectomies

Baptista

Paulo²,

Paulo³

et al. 2008

Acta Cir. Bras.

View full text Add to dashboard Cite

PURPOSE: To study the safety and efficiency of two anesthetic blockages in hemorroidectomy and the effect of clonidine on analgesia. METHODS: 80 patients were studied, randomly divided into four groups: l (n=19)- peridural with a 0,75% ropivacaine; 2 (n=21)-peridural with a 0,75% ropivacaine and 150 µg of clonidine; 3 (n=19)- subarachnoid with a 0,5% bupivacaine; 4 (n=21)- subarachnoid with a 0,5% bupivacaine and 50 µg of clonidine. The intensity of pain was evaluated by the visual analogical scale 8, 12 and 24 hours after surgery. The use of vasoconstrictors on the transoperatory and the amount of analgesics within the 24 hours were registered. RESULTS: The intensity of pain, 8 hours after surgery, was lesser on group 4, and much lesser on group 4 comparing with groups 1 and 2, 12 hours (p=0,022; p=0,001) and 24 hours (p=0,03; p=0,003). The frequency of vasoconstrictors usage on the transoperatory and the analgesics on the post-operatory showed no difference among the groups. There were no anesthetic complications. CONCLUSIONS: The subarachnoid anesthesia with a 0,5% bupivacaine with clonidine, showed better analgesia comparing with the peridural anesthesia with a 0,75% ropivacaine with or without clonidine, however all were safe and efficient. The clonidine aided on the decreasing of pain when subarachnoid anesthesia was used.

show abstract

“…Vários estudos de eletromanometria anorretal demonstraram que, pacientes portadores de doença hemorroidária, podem apresentar pressão do canal anal aumentada, semelhantemente ao que ocorre na fissura anal 4,5,7,8 . Existem vários relatos na literatura que mostram que a hipertonia do esfíncter interno do ânus exerce um papel etiológico, tanto no desenvolvimento da fissura anal, como na doença hemorroidária 6,9 . Alguns autores sugerem que a esfincterotomia lateral interna associada à hemorroidectomia, pode contribuir para uma melhor evolução clínica no pós-operatório (redução da dor, da retenção urinária, da estenose anal e do tempo de cicatrização da ferida operatória) 4,[10][11][12][13] .…”

Section: Introducãounclassified

Esfincterotomia lateral interna associada à hemorroidectomia no tratamento da doença hemorroidária: vantagem ou desvantagem?

Moreira¹,

Moreira²,

Iguma³

et al. 2007

Rev bras. colo-proctol.

View full text Add to dashboard Cite

Randomized, prospective, double-blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy

Abstract: Perianal application of 0.2 percent nitroglycerin ointment after hemorrhoidectomy significantly reduced narcotic requirements on the second postoperative day. Headaches and a subsequent need for nonnarcotic medications may limit benefits of nitroglycerin.

Cited by 81 publications

References 15 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

Epidural anesthesia using a 0,75% ropivacaine and subarachnoid anesthesia with a 0,5% bupivacaine associated or not with clonidine in hemorroidectomies

Esfincterotomia lateral interna associada à hemorroidectomia no tratamento da doença hemorroidária: vantagem ou desvantagem?

Contact Info

Product

Resources

About