BACKGROUND: Postoperative pain after stapled hemorrhoidopexy (SH) is cause for considerable concern and may be related to contracture of continence muscles. OBJECTIVE: We compared glyceryl trinitrate (GTN) 0.4% ointment with lidocaine chlorhydrate (LIDO) 2.5% gel as topical therapy to relieve the pain of anorectal muscular spasm after SH. DESIGN: This was a randomized, single-blind, parallel-group and controlled trial. SETTINGS: The study were entirely conducted at the St. Andrea Hospital of Rome, Italy. PATIENTS: Patients suffering postoperative anal pain after SH, with elevated anal resting pressure, were enrolled, excluding those treated for concomitant anorectal disease. INTERVENTIONS: Subjects were randomly assigned to twice-daily locally-applied topical medication (GTN or LIDO) for a total of 14 days. MAIN OUTCOME MEASURES: Pain intensity (at baseline and at Days 2,7, and 14 of therapy) and anal resting pressure (at baseline and at Day 14 of therapy) were quantified by visual analogue scale (VAS) and anorectal manometry (ARM), respectively. RESULTS: Forty-one patients were studied. As specified, VAS scores (Day 2, 2.5±1.0 vs 4.0±1.1, p<0.0001; Day 7, 1.4 vs 2.8, p < 0.0001; Day 14, 0.4 vs 1.4, p = 0.003) and ARM values (baseline, 113±9.3 mmHg vs 113±9.2 mmHg, p=0.754; Day 14, 75.4 ±7.4 mmHg vs 85.6 ±7.9 mmHg, p<0.0001) showed faster, more effective pain relief and reduction in anal resting pressure with GTN vs LIDO. LIMITATIONS: Investigators were not blinded to the treatment groups. ARM was done only on patients suspected of having anal hypertonia at digital rectal examination and who actually had hypertonia may not have been identified. The performance of ARM only at Day 14 of treatment made us lose the possibility to evaluate patients earlier (at Day 7), when pain was more intense. CONCLUSIONS: After SH, topical 0.4% GTN is effective in relieving pain in patients in whom anal hypertonia is identified.
Topical glyceryl trinitrate ointment for pain related to anal hypertonia after stapled hemorrhoidopexy: a randomized controlled trial / Mari, Francesco Saverio; Nigri, Giuseppe; Dall'Oglio, A; Cosenza, Um; Milillo, A; Terrenato, I; Pancaldi, A; Brescia, Antonio. - In: DISEASES OF THE COLON & RECTUM. - ISSN 0012-3706. - STAMPA. - 6:56(2013), pp. 768-773. [10.1097/DCR.0b013e31828b282c]
Topical glyceryl trinitrate ointment for pain related to anal hypertonia after stapled hemorrhoidopexy: a randomized controlled trial.
MARI, Francesco Saverio;NIGRI, Giuseppe;BRESCIA, Antonio
2013
Abstract
BACKGROUND: Postoperative pain after stapled hemorrhoidopexy (SH) is cause for considerable concern and may be related to contracture of continence muscles. OBJECTIVE: We compared glyceryl trinitrate (GTN) 0.4% ointment with lidocaine chlorhydrate (LIDO) 2.5% gel as topical therapy to relieve the pain of anorectal muscular spasm after SH. DESIGN: This was a randomized, single-blind, parallel-group and controlled trial. SETTINGS: The study were entirely conducted at the St. Andrea Hospital of Rome, Italy. PATIENTS: Patients suffering postoperative anal pain after SH, with elevated anal resting pressure, were enrolled, excluding those treated for concomitant anorectal disease. INTERVENTIONS: Subjects were randomly assigned to twice-daily locally-applied topical medication (GTN or LIDO) for a total of 14 days. MAIN OUTCOME MEASURES: Pain intensity (at baseline and at Days 2,7, and 14 of therapy) and anal resting pressure (at baseline and at Day 14 of therapy) were quantified by visual analogue scale (VAS) and anorectal manometry (ARM), respectively. RESULTS: Forty-one patients were studied. As specified, VAS scores (Day 2, 2.5±1.0 vs 4.0±1.1, p<0.0001; Day 7, 1.4 vs 2.8, p < 0.0001; Day 14, 0.4 vs 1.4, p = 0.003) and ARM values (baseline, 113±9.3 mmHg vs 113±9.2 mmHg, p=0.754; Day 14, 75.4 ±7.4 mmHg vs 85.6 ±7.9 mmHg, p<0.0001) showed faster, more effective pain relief and reduction in anal resting pressure with GTN vs LIDO. LIMITATIONS: Investigators were not blinded to the treatment groups. ARM was done only on patients suspected of having anal hypertonia at digital rectal examination and who actually had hypertonia may not have been identified. The performance of ARM only at Day 14 of treatment made us lose the possibility to evaluate patients earlier (at Day 7), when pain was more intense. CONCLUSIONS: After SH, topical 0.4% GTN is effective in relieving pain in patients in whom anal hypertonia is identified.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
