Systemic Metronidazole May Not Reduce Posthemorrhoidectomy Pain: A Meta-Analysis of Randomized Controlled Trials

Abstract

Although a favorable adverse effect profile supports consideration of oral metronidazole to reduce posthemorrhoidectomy pain, pooled analysis reveals inconsistent results with no pain reduction on most postoperative days. The current recommendation for routine prescription of oral metronidazole should be reevaluated in the absence of additional well-designed trials.

Systematic review and meta‐analysis of the role of metronidazole in post‐haemorrhoidectomy pain relief

“…In this analysis we have presented evidence that prophylactic metronidazole significantly reduces pain posthaemorrhoidectomy on days 1, 2 and 7 as well as on first defaecation, a finding made all the more interesting by the recent publication of a similar meta-analysis assessing the effectiveness of oral route only metronidazole on days 1-7 [15]. Wanis et al demonstrated a reduction in pain on days 1 and 4 but found no difference on days 5-7 and thus concluded that metronidazole did not reduce postoperative pain.…”

“…Whilst metronidazole is used to reduce postoperative pain following CH, there is a lack of consensus as to its effectiveness with studies of variable quality and design demonstrating conflicting results. Further, a recent systematic review and meta‐analysis concluded that there is no demonstrable benefit of oral metronidazole on post‐haemorrhoidectomy pain . This review did not consider the use of topical metronidazole preparations, which are a commonly used route of administration.…”

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

“…The use of oral metronidazole in controlling postoperative pain was recently evaluated in two meta-analysis with conflicting results [186,187].…”

Metronidazole following excisional haemorrhoidectomy: a systematic review and meta‐analysis

“…Wanis et al .’s earlier systematic review included only the oral route and concluded that metronidazole did not reduce post‐operative pain following a sensitivity analysis that excluded the largest single study that had previously been conducted . With the subsequent inclusion of only five papers in their meta‐analysis, they analysed a significantly reduced study population of 168 compared with our 523.…”