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

Abstract

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.

Comparison of efficacy of internal sphincterotomy versus topical 0.2 % glyceryl trinitrate ointment after hemorrhoidectomy.

“…3 During the time period, multiple methods have been incorporated to reduce this pain, including 0,2% Glyceryl Trinitrate (GTN), 0,4% GTN and 2% Lignocaine gel, as the topic of topical application. [4][5] The ointment of glyceryl trinitrate works as an inner anal sphincter dilator whereas 0.2 GTN reduces pain in the first week following operation. 4 Numerous studies have been done on this subject.…”

“…The group that used GTN experienced a significant reduction in pain for the first few weeks following the operation with the help of the Visual Analog Scale for 7 days of a study of the pain intensity. [5][6] https://doi.org/10.29309/TPMJ/2020. 27.12.4728 Postoperative pain both at rest and during defecation and healing time has been determined to decrease significantly if patients receive postoperative treatment with GTN.…”

Effect of Glyceryl Trinitrate Ointment on Pain Control After Hemorrhoidectomy: A Meta‐analysis of Randomized Controlled Trials

“…These 12 trials were published between 2001 and 2014 and had sample sizes ranging from 20 to 210 patients. Nine trials recruited patients with third‐ and fourth‐degree hemorrhoid [10, 14, 15, 19, 20, 22–26]. Milligan–Morgan hemorrhoidectomy was performed in the majority of the included trials; Ferguson‐closed hemorrhoidectomy was performed in 2 studies [20, 25], and stapled hemorrhoidectomy was performed in 2 trials [14, 21].…”

“…However, this review did not clarify the heterogeneity of the pooled results, which is crucial in the random effects model [13]. Moreover, several RCTs evaluating GTN in pain control after hemorrhoidectomy have been published recently [14, 15]. Therefore, through a systematic review and meta‐analysis of the evidence available to date, we investigated the outcome in patients using GTN topically after hemorrhoidectomy.…”

Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

“…Glyceryl trinitrate ointment improved wound healing and reduced postoperative pain [28]. A recent randomized trial confirmed these results [29]. However, this benefit was not confirmed after stapled hemorrhoidopexy [30].…”