Una sola dosis de diclofenaco intrarrectal reduce la retención urinaria tras la cirugía de las hemorroides. Resultados de un estudio clínico controlado y aleatorizado

Galán, Carlos Placer; Mujika, José Andrés; Elósegui, José Luis; Irureta, Idoia; Bollo, Elisabet; Esteban, Elena; Enríquez-Navascués, José María

doi:10.1016/s0009-739x(08)70580-3

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…However, when stratifying by gender and surgery type, women operated of three hemorrhoidal packs who received topical treatment CLIFE1 significantly diminish the TTFV (at almost half) versus the ones who are under CLIFE2. These results coincide with other studies which show a correlation between pain and micturition difficulties 44 , as well as with one study that displays a pain reduction and minor percentage of post-hemorrhoidectomy urinary retention, after a dose of rectal diclofenac administered by the surgeon at the end of the hemorrhoidectomy 29 .…”

Section: Discussionsupporting

confidence: 92%

“…Other authors compare topical lidocaine alone 26 , 27 or lidocaine plus prilocaine (EMLA cream) 28 with a rectal diclofenac suppository administered in one dose by the surgeon at the end of hemorrhoidectomy. The results show higher analgesic efficacy for EMLA after the first two hours post-hemorrhoidectomy, however diclofenac is more effective in the evening after surgery and in the morning of the day after, as well as in reducing urinary retention events 29 .…”

Section: Introductionmentioning

confidence: 85%

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Topical Analgesia with Lidocaine Plus Diclofenac Decreases Pain in Benign Anorectal Surgery: Randomized, Doubleblind, and Controlled Clinical Trial

Linares-Gil

Valls

Hereu-Boher

et al. 2018

Clinical and Translational Gastroenterology

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ObjectiveThe aim of this study is to evaluate the efficacy and safety of a topical formulation containing lidocaine plus diclofenac (CLIFE1) compared to lidocaine (CLIFE2), to decrease pain in benign anorectal surgery (BARS) to date not evaluated. More than 50% of patients undergoing BARS, especially hemorrhoidectomy, suffer from moderate and severe postoperative pain. This remains an unresolved problem that could be addressed with the new CLIFE1 topical treatment.MethodsA multicenter, randomized double-blind, active-controlled parallel-group superiority trial, was conducted in two Spanish hospitals. Patients undergoing BARS (hemorrhoids, anal fistula and anal fissure) were randomized at the end of surgery at a 1:1 ratio to receive first dose either CLIFE1 (n = 60) or CLIFE2 (n = 60) anorectal topical treatment, and after every 12 h for the first three postoperative days and once a day from the fourth to sixth. The primary outcome was average of pain decrease after topical treatment, measured with visual analogue scale (VAS) by the patients themselves, the evening in the surgery day and four times daily for the first three postoperative days.ResultsThe results of 120 patients included out of 150 selected undergoing BARS show a decrease in pain after CLIFE1 topical treatment (7.47 ± 13.09) greater than with CLIFE2 (4.38 ± 6.75), difference −3.21 95% CI (−5.75; −0.68), p = 0.008, decreasing significantly postoperative pain ( ≥ 9 mm, VAS) in 35% of patients undergoing benign anorectal surgery, compared to 18.33 % treated with lidocaine.ConclusionsThe CLIFE1 topical treatment shows better analgesic efficacy than CLIFE2 in BARS.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 85%

Topical Analgesia with Lidocaine Plus Diclofenac Decreases Pain in Benign Anorectal Surgery: Randomized, Doubleblind, and Controlled Clinical Trial

Linares-Gil

Valls

Hereu-Boher

et al. 2018

Clinical and Translational Gastroenterology

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“…Forty-four 17 , 18 , 20 , 21 , 23 – 26 , 28 , 30 – 53 , 55 , 56 , 58 – 63 RCTs with 12 interventions and 5338 patients were included; see the network map in Figure 2 . Although all interventions reduced POUR, only AMB, ACU, ALP and NSD were statistically significant compared with placebo, but none of the indirect comparisons was significant; see Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Medical and non-medical interventions for post-operative urinary retention prevention: network meta-analysis and risk–benefit analysis

Sirisreetreerux

Wattanayingcharoenchai

Rattanasiri

et al. 2021

Therapeutic Advances in Urology

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Aims: To assess the efficacy in lowering post-operative urinary retention, urinary tract infection and lower urinary tract symptoms and the incidence of adverse events among 12 interventions and to perform risk–benefit analysis. Methods: Previous randomized controlled trials were identified from MEDLINE, Scopus and CENTRAL database up to January 2020. The interventions of interest included early ambulation, fluid adjustment, neuromodulation, acupuncture, cholinergic drugs, benzodiazepine, antispasmodic agents, opioid antagonist agents, alpha-adrenergic antagonists, non-steroidal anti-inflammatory drugs (NSAIDs) and combination of any interventions. The comparators were placebo or standard care or any of these interventions. Network meta-analysis was performed. The probability of being the best intervention was estimated and ranked using rankogram and surface under the cumulative ranking curve. Risk–benefit analysis was done. Incremental risk–benefit ratio (IRBR) was calculated and risk–benefit acceptability curve was constructed. Results: A total of 45 randomized controlled trials with 5387 patients was included in the study. Network meta-analysis showed that early ambulation, acupuncture, alpha-blockers and NSAIDs significantly reduced the post-operative urinary retention. Regarding urinary tract infection and lower urinary tract symptoms, no statistical significance was found among interventions. Regarding the side effects, only alpha-adrenergic antagonists significantly increased the adverse events compared with acupuncture and opioid antagonist agents from the indirect comparison. According to the cluster ranking plot, acupuncture and early ambulation were considered high efficacy with low adverse events, corresponding to the IRBR. Conclusion: Early ambulation, acupuncture, opioid antagonist agents, alpha-adrenergic antagonists and NSAIDs significantly reduce the incidence of post-operative urinary retention with no difference in adverse events. Regarding the risk–benefit analysis of the medical treatment, alpha-adrenergic antagonists have the highest probability of net benefit at the acceptable threshold of side effect of 15%, followed by opioid antagonist agents, NSAIDs and cholinergic drugs.

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Systematic review of interventions for the prevention and treatment of postoperative urinary retention

et al. 2018

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BackgroundPostoperative urinary retention (PO‐UR) is an acute and painful inability to void after surgery that can lead to complications and delayed hospital discharge. Standard treatment with a urinary catheter is associated with a risk of infection and can be distressing, undignified and uncomfortable. This systematic review aimed to identify effective interventions for the prevention and treatment of PO‐UR that might be alternatives to urinary catheterization.MethodsElectronic databases were searched from inception to September 2017. Randomized trials of interventions for the prevention or treatment of PO‐UR were eligible for inclusion. Studies were assessed for risk of bias using the Cochrane (2.0) tool. Two reviewers were involved at all review stages. Where possible, data were pooled using random‐effects meta‐analysis. The overall quality of the body of evidence was rated using the GRADE approach.ResultsSome 48 studies involving 5644 participants were included. Most interventions were pharmacological strategies to prevent PO‐UR. Based on GRADE, there was high‐certainty evidence to support replacing morphine in a regional anaesthetic regimen, using alpha‐blockers (number needed to treat to prevent one case of PO‐UR (NNT) 5, 95 per cent c.i. 5 to 7), the antispasmodic drug drotaverine (NNT 9, 7 to 30) and early postoperative mobilization (NNT 5, 4 to 8) for prevention, and employing hot packs or gauze soaked in warm water for treatment (NNT 2, 2 to 4). Very few studies reported on secondary outcomes of pain, incidence of urinary tract infection or duration of hospital stay.ConclusionPromising interventions exist for PO‐UR, but they need to be evaluated in randomized trials investigating comparative clinical and cost effectiveness, and acceptability to patients.

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Una sola dosis de diclofenaco intrarrectal reduce la retención urinaria tras la cirugía de las hemorroides. Resultados de un estudio clínico controlado y aleatorizado

Cited by 5 publications

References 18 publications

Topical Analgesia with Lidocaine Plus Diclofenac Decreases Pain in Benign Anorectal Surgery: Randomized, Doubleblind, and Controlled Clinical Trial

Topical Analgesia with Lidocaine Plus Diclofenac Decreases Pain in Benign Anorectal Surgery: Randomized, Doubleblind, and Controlled Clinical Trial

Medical and non-medical interventions for post-operative urinary retention prevention: network meta-analysis and risk–benefit analysis

Systematic review of interventions for the prevention and treatment of postoperative urinary retention

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