Background: Spasm through the internal anal sphincter is one of the supposed causes for pain after hemorrhoidectomy, a common and distressing experience. We hypothesized that the addition of topical nifedipine to lidocaine would improve pain control by causing a relaxation of the smooth muscle of the internal anal sphincter.
Methods: We conducted a multicentre randomized, double-blind trial to compare the efficacy of 0.3% nifedipine and 1.5% lidocaine ointment versus 1.5% lidocaine ointment alone in reducing pain after hemorrhoidectomy. A physician unaware of the treatment arm measured pain by use of the Analogue Chromatic Continuous Scale (ACCS) at baseline; soon after surgery; at 2, 4, 6, 8 and 24 hours after surgery; on day 7 after surgery; and at a final visit 14 days after surgery. The physician also noted the time to first analgesic administration within 24 hours after surgery.
Results: In all, 135 patients per group participated (270 total). Evaluation of the delta ACCS score versus basal value, a covariate for rescue analgesic administration time, revealed better pain control in the group that received nifedipine with lidocaine at 6 hours after surgery and on day 7 (p < 0.011 and p < 0.054, respectively). We noticed no difference between groups for time of administration of rescue analgesic, blood pressure, heart rate or frequency of headache.
Conclusion: Although there was no difference between groups for time of administration of rescue analgesic after open hemorrhoidectomy, the patients' assessment of pain using ACCS showed that the use of topical nifedipine with lidocaine may provide a slight significant difference in favour of the study group at 6 hours and at day 7 after surgery. Narcotic analgesics and nonsteroidal anti-inflammatory drug administration should continue to be recommended. Further research focusing on these outcomes is warranted.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810010 | PMC |
Publication Analysis
Top Keywords
Similar Publications
Temporal trends and treatment patterns in anal fissure management: insights from a multicenter study in Italy.
Tech Coloproctol
October 2024
Oncology and Gastroenterology - DiSCOG, University of Padova, Padua, Italy.
Article Synopsis
- A multicenter study by the Italian Society of Colorectal Surgery examined treatment trends for anal fissures (AF) over a decade, focusing on various treatment approaches based on AF presentation and sphincter function.
- Data from 22,016 patients showed significant variability in treatment methods influenced by factors like symptom duration and surgeon preference, with conservative treatments being the most common.
- The study emphasizes the evolving nature of AF management and calls for more research to identify the best treatment strategies for improved patient outcomes.
Description and management of patients with anal fissure: insights on Italian primary care setting coming from real-world data.
Updates Surg
October 2024
Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
Article Synopsis
- The study analyzed data from 8632 patients aged 18 and older with anal fissures (AF) from an Italian health database, focusing on their management and treatment between July 2016 and June 2021.
- Only 14% of patients received a combination topical treatment of nifedipine and lidocaine (NIF/LID) at the time of their first AF record, highlighting low treatment rates despite increasing healthcare resource use during follow-up.
- Findings indicated that younger patients were more likely to receive NIF/LID and that there is a significant gap between recommended treatment guidelines and actual management practices, suggesting a need for educational campaigns about anal health in primary care.
The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure.
BMC Surg
October 2023
Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy.
Introduction: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature.
Methods: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached.
The Value of Injection Therapy with Botulinum Toxin in Pain Treatment of Primary Chronic Anal Fissures Compared to Anal Dilation, and Local Nifedipine in Combination with Lidocaine.
Pril (Makedon Akad Nauk Umet Odd Med Nauki)
July 2023
2Мacedonian Academy of Sciences and Arts, Skopje, RN Macedonia.
: Anal fissure is a longitudinal tear of the mucosa of the anal canal extending from the outer anal orifice in the direction of the dentate line of the inner anal opening. Fissures are divided into primary and secondary, and acute or chronic. Besides minimal rectal bleeding, itching and soiling, primary chronic anal fissures (PCAF) manifest with anal pain as theirs main determinant.
View Article and Find Full Text PDFEvaluation of three different Tc-based mock-venom agents for lymphoscintigraphy studies in preclinical models of peripheral snakebite envenomation.
J Pharmacol Toxicol Methods
July 2023
Department of Combat Sciences, Institute of Nuclear Medicine and Allied Sciences, Defence Research & Development Organisation, New Delhi 110054, India. Electronic address:
Snakebite envenomation is one of the major public health concerns across many countries; with the WHO designating it as a 'priority neglected tropical disease' and stressing for a need to develop novel therapeutic strategies to reduce death and disability rate by end of 2030. Since a major component of venom; the high molecular weight (HMw) toxins enter the bloodstream through lymphatic system, research is focusing on modulating the lymphatic flow rate after topical application of suitable drug candidates. Present study compared the suitability of three radiopharmaceutical agents, namely Tc-Sulfur colloid (SC), Tc-Phytate (Phy) and Tc-Human serum albumin (HSA), to be used as mock-venom agent in studying modulation in lymphatic flow rate in preclinical models of peripheral snakebite envenomation using lymphoscintigraphy studies.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!