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Randomised clinical trial of effect of oral nifedipine on pain and healing after hemorrhoidectomy

Yıl 2007, Cilt: 12 Sayı: 1-2, 15 - 20, 20.03.2013

Öz

Abstract. Hemorrhoidectomy has the best long-term results and is the only effective treatment for symptomatic third and fourth degree hemorrhoids. Patients and doctors consider it a painful operation. Nifedipine reduces the activity of the internal anal sphincter and relieves symptoms in patients with haemorrhoids or anal fissure. The aim of this study was to evaluate the effect of oral nifedipine after haemorrhoidectomy.We randomly assigned 40 consecutive patients admitted for hemorrhoidectomy by Milligan Morgan technique. Group 1 (n=20) is the control group, group 2 (n=20) is the study group. All received habitual treatment; lactulose as stool softener, metronidazole 500 mg three times daily for seven postoperative days, and ketorolac tromethamine as analgesic. Group 2 additionally received oral nifedipine 20 mg twice daily from 2 days before surgery until wound healing. Linear analog scales were used to assess pain. Time to first bowel movement, return to normal activity, complications, and use of additional analgesics were recorded. Patients were reviewed and assessed postoperatively every week for measurement of blood pressure, pulse rate, wound healing and adverse effects until return to work. Patients in the oral nifedipine group had significantly less pain, less analgesics consumption [median 18 (12 - 38) vs 33 (25 - 48)] (p=0,021). Median time to healing the wounds was 28 days (range 14 - 40) in the oral nifedipine group and 40 days (21 - 60) in the control group (P=0,023). Median time to return to work or normal activity was 37.5 days (range 20 - 80) in the oral nifedipine group and 47.5 days (20 - 115) in the control group (P=0,445). There was no significant change in baseline pulse rate or systolic and diastolic blood pressure. Headache occurred in 4 patients who responded to paracetamol. The use of oral nifedipine reduced postoperative pain, analgesic consumption, and promoted earlier wounds healing and return to work. And we suggest its inclusion in routine posthemorrhoidectomy treatment.

Key words: Nifedipine, hemorrhoids, hemorrhoidectomy, postoperative pain, wound healing

Kaynakça

  • 1. MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A metaanalysis. Dis Colon Rectum 1995; 38: 687-694.
  • 2. Seow-Choen F, Ho YH, Ang HG, Goh HS. Prospective, randomised trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoids. Dis Colon Rectum 1992; 35: 1165-1169.
  • 3. Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic Scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum 2001; 44: 558-564.
  • 4. Jayne DG, Botterill I, Ambrose NS, Brennan TG, Guillou PJ, O’Riordain DS. Randomized clinical trial of Ligasure versus conventional diathermy for day-case haemorrhoidectomy. Br J Surg 2002; 89: 428-432.
  • 5. Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with circular suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery. 1998 June 3; Rome, Italy. Rome: Mundozzi Editor; 1998: 777-784.
  • 6. Thwayeb Y, Gonzalez Hermoso. Randomized Clinical Trial of Longo´s Technique Versus Milligan Morgan’s Haemorrhoidectomy; Followup Three Years. Eastern Journal of Medicine 2004; 9: 34-38.
  • 7. Galizia G, Lieto E, Castellano P, Pelosio L, Imperatore V, Pigantelli C. Lateral internal sphincterotomy together with haemorrhoidectomy for treatment of haemorrhoids: a randomised prospective study. Eur J Surg 2000; 166: 223-228.
  • 8. Coskun A, Duzgun SA, Uzunkoy A, Bozer M, Aslan O, Canbeyli B. Nitroderm TTS band application for pain after hemorrhoidectomy. Dis Colon Rectum 2001; 44: 680-685.
  • 9. Wasvary HJ, Hain J, Mosed-Vogel M, Bendick P, Barkel DC, Klein SN. Randomized, prospective, double-blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy. Dis Colon Rectum 2001; 44: 1069-1073.
  • 10. Vinson-Bonnet B, Coltat JC, Fingerhut A, Bonnet F. Local infiltration with ropivacaine improves immediate postoperative pain control after hemorrhoidal surgery. Dis Colon Rectum 2002; 45: 104-108.
  • 11. Luck AJ, Hewett PJ. Ischiorectal fossa block decreases posthemorrhoidectomy pain: randomized, prospective, double-blind clinical trial. Dis Colon Rectum 2000; 43: 142-145.
  • 12. Carapeti EA, Kamm MA, McDonald PJ, Phillips RK. Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet 1998; 351: 169-172.
  • 13. Chrysos E, Xynos E, Tzovaras G, Zoras OJ, Tsiaoussis J, Vassilakis SJ. Effect of nifedipine on rectoanal motility. Dis Colon Rectum. 1996; 39: 212-216.
  • 14. Perrotti P; Antropoli C; Molino D; De Stefano G; Antropoli M. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum 2001; 44: 405-409.
  • 15. Hodgson WJ, Morgan J. Ambulatory hemorrhoidectomy with CO2 laser. Dis Colon Rectum 1995; 38: 1265-1269.
  • 16. Rudd WW. Ligation and cryosurgery of all hemorrhoids: an office procedure. Int Surg 1989; 74: 148-151.
  • 17. Pfenninger JL. Modern treatments for internal haemorrhoids. BMJ 1997; 314: 1211-1212.
  • 18. Cheng FC, Shum DW, Ong GB. The treatment of second degree haemorrhoids by injection, rubber band ligation, maximal anal dilatation, and haemorrhoidectomy: a prospective clinical trial. Aust N Z J Surg 1981; 51: 458-462.
  • 19. Santos G, Novell JR, Khoury G, Winslet MC, Lewis AAM. Long-term results of large-dose, single-session phenol injection sclerotherapy for hemorrhoids. Dis Colon Rectum 1993; 36: 958- 961.
  • 20. Scarpa FJ, Hillis W, Sabetta JR. Pelvic cellulitis: a life-threatening complication of hemorrhoidal banding. Surgery 1988; 103: 383-385.
  • 21. Adami B, Eckardt VF, Suermann RB, Karbach U, Ewe K. Bacteremia after proctoscopy and hemorrhoidal injection sclerotherapy. Dis Colon Rectum 1981; 24: 373-374.
  • 22. Bullock N. Impotence after sclerotherapy of haemorrhoids: case reports. BMJ 1997; 314: 419.
  • 23. Cook TA, Brading AF, Mortensen NJM Differences in contractile properties of anorectal smooth muscle and the effect of calcium channel blockade. Br J Surg 1999; 86: 70-75.
  • 24. Cook TA, Brading AF, Mortensen NJM: Effect of nifedipine on anorectal smooth muscle in vitro. Dis Colon Rectum 1999; 42: 782-787.
  • 25. Antropoli C, Perroti P, Rubino M Nifedipine for local use in conservative treatment of anal fissures Preliminary results of multicenter study. Dis Colon Rectum 1999; 42: 1011-1015.
  • 26. Agaoglu N Cengiz S Arslan MK Turkyilmaz S Oral nifedipine in the treatment of chronic anal fissure. Dig Surg 2003; 20: 452-456.
  • 27. Thaha MA, Irvine LA, Steele RJ, Campbell KL. Postdefaecation pain syndrome after circular stapled anopexy is abolished by oral nifedipine. Br J Surg 2005; 92: 208-210.
  • 28. Perrotti P, Dominici P, Grossi E, Antropoli C, Giannotti G, Cusato M, Regazzi M, Cerutti R.Pharmacokinetics of anorectal nifedipine and lidocaine (lignocaine) ointment following haemorrhoidectomy: an open-label, single-dose, phase IV clinical study. Clin Drug Investig 2009; 29: 243-256.
Yıl 2007, Cilt: 12 Sayı: 1-2, 15 - 20, 20.03.2013

Öz

Kaynakça

  • 1. MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A metaanalysis. Dis Colon Rectum 1995; 38: 687-694.
  • 2. Seow-Choen F, Ho YH, Ang HG, Goh HS. Prospective, randomised trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoids. Dis Colon Rectum 1992; 35: 1165-1169.
  • 3. Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic Scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum 2001; 44: 558-564.
  • 4. Jayne DG, Botterill I, Ambrose NS, Brennan TG, Guillou PJ, O’Riordain DS. Randomized clinical trial of Ligasure versus conventional diathermy for day-case haemorrhoidectomy. Br J Surg 2002; 89: 428-432.
  • 5. Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with circular suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery. 1998 June 3; Rome, Italy. Rome: Mundozzi Editor; 1998: 777-784.
  • 6. Thwayeb Y, Gonzalez Hermoso. Randomized Clinical Trial of Longo´s Technique Versus Milligan Morgan’s Haemorrhoidectomy; Followup Three Years. Eastern Journal of Medicine 2004; 9: 34-38.
  • 7. Galizia G, Lieto E, Castellano P, Pelosio L, Imperatore V, Pigantelli C. Lateral internal sphincterotomy together with haemorrhoidectomy for treatment of haemorrhoids: a randomised prospective study. Eur J Surg 2000; 166: 223-228.
  • 8. Coskun A, Duzgun SA, Uzunkoy A, Bozer M, Aslan O, Canbeyli B. Nitroderm TTS band application for pain after hemorrhoidectomy. Dis Colon Rectum 2001; 44: 680-685.
  • 9. Wasvary HJ, Hain J, Mosed-Vogel M, Bendick P, Barkel DC, Klein SN. Randomized, prospective, double-blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy. Dis Colon Rectum 2001; 44: 1069-1073.
  • 10. Vinson-Bonnet B, Coltat JC, Fingerhut A, Bonnet F. Local infiltration with ropivacaine improves immediate postoperative pain control after hemorrhoidal surgery. Dis Colon Rectum 2002; 45: 104-108.
  • 11. Luck AJ, Hewett PJ. Ischiorectal fossa block decreases posthemorrhoidectomy pain: randomized, prospective, double-blind clinical trial. Dis Colon Rectum 2000; 43: 142-145.
  • 12. Carapeti EA, Kamm MA, McDonald PJ, Phillips RK. Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet 1998; 351: 169-172.
  • 13. Chrysos E, Xynos E, Tzovaras G, Zoras OJ, Tsiaoussis J, Vassilakis SJ. Effect of nifedipine on rectoanal motility. Dis Colon Rectum. 1996; 39: 212-216.
  • 14. Perrotti P; Antropoli C; Molino D; De Stefano G; Antropoli M. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum 2001; 44: 405-409.
  • 15. Hodgson WJ, Morgan J. Ambulatory hemorrhoidectomy with CO2 laser. Dis Colon Rectum 1995; 38: 1265-1269.
  • 16. Rudd WW. Ligation and cryosurgery of all hemorrhoids: an office procedure. Int Surg 1989; 74: 148-151.
  • 17. Pfenninger JL. Modern treatments for internal haemorrhoids. BMJ 1997; 314: 1211-1212.
  • 18. Cheng FC, Shum DW, Ong GB. The treatment of second degree haemorrhoids by injection, rubber band ligation, maximal anal dilatation, and haemorrhoidectomy: a prospective clinical trial. Aust N Z J Surg 1981; 51: 458-462.
  • 19. Santos G, Novell JR, Khoury G, Winslet MC, Lewis AAM. Long-term results of large-dose, single-session phenol injection sclerotherapy for hemorrhoids. Dis Colon Rectum 1993; 36: 958- 961.
  • 20. Scarpa FJ, Hillis W, Sabetta JR. Pelvic cellulitis: a life-threatening complication of hemorrhoidal banding. Surgery 1988; 103: 383-385.
  • 21. Adami B, Eckardt VF, Suermann RB, Karbach U, Ewe K. Bacteremia after proctoscopy and hemorrhoidal injection sclerotherapy. Dis Colon Rectum 1981; 24: 373-374.
  • 22. Bullock N. Impotence after sclerotherapy of haemorrhoids: case reports. BMJ 1997; 314: 419.
  • 23. Cook TA, Brading AF, Mortensen NJM Differences in contractile properties of anorectal smooth muscle and the effect of calcium channel blockade. Br J Surg 1999; 86: 70-75.
  • 24. Cook TA, Brading AF, Mortensen NJM: Effect of nifedipine on anorectal smooth muscle in vitro. Dis Colon Rectum 1999; 42: 782-787.
  • 25. Antropoli C, Perroti P, Rubino M Nifedipine for local use in conservative treatment of anal fissures Preliminary results of multicenter study. Dis Colon Rectum 1999; 42: 1011-1015.
  • 26. Agaoglu N Cengiz S Arslan MK Turkyilmaz S Oral nifedipine in the treatment of chronic anal fissure. Dig Surg 2003; 20: 452-456.
  • 27. Thaha MA, Irvine LA, Steele RJ, Campbell KL. Postdefaecation pain syndrome after circular stapled anopexy is abolished by oral nifedipine. Br J Surg 2005; 92: 208-210.
  • 28. Perrotti P, Dominici P, Grossi E, Antropoli C, Giannotti G, Cusato M, Regazzi M, Cerutti R.Pharmacokinetics of anorectal nifedipine and lidocaine (lignocaine) ointment following haemorrhoidectomy: an open-label, single-dose, phase IV clinical study. Clin Drug Investig 2009; 29: 243-256.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Articles
Yazarlar

Yousef Thwayeb Bu kişi benim

Yayımlanma Tarihi 20 Mart 2013
Yayımlandığı Sayı Yıl 2007 Cilt: 12 Sayı: 1-2

Kaynak Göster

APA Thwayeb, Y. (2013). Randomised clinical trial of effect of oral nifedipine on pain and healing after hemorrhoidectomy. EASTERN JOURNAL OF MEDICINE, 12(1-2), 15-20.
AMA Thwayeb Y. Randomised clinical trial of effect of oral nifedipine on pain and healing after hemorrhoidectomy. EASTERN JOURNAL OF MEDICINE. Mart 2013;12(1-2):15-20.
Chicago Thwayeb, Yousef. “Randomised Clinical Trial of Effect of Oral Nifedipine on Pain and Healing After Hemorrhoidectomy”. EASTERN JOURNAL OF MEDICINE 12, sy. 1-2 (Mart 2013): 15-20.
EndNote Thwayeb Y (01 Mart 2013) Randomised clinical trial of effect of oral nifedipine on pain and healing after hemorrhoidectomy. EASTERN JOURNAL OF MEDICINE 12 1-2 15–20.
IEEE Y. Thwayeb, “Randomised clinical trial of effect of oral nifedipine on pain and healing after hemorrhoidectomy”, EASTERN JOURNAL OF MEDICINE, c. 12, sy. 1-2, ss. 15–20, 2013.
ISNAD Thwayeb, Yousef. “Randomised Clinical Trial of Effect of Oral Nifedipine on Pain and Healing After Hemorrhoidectomy”. EASTERN JOURNAL OF MEDICINE 12/1-2 (Mart 2013), 15-20.
JAMA Thwayeb Y. Randomised clinical trial of effect of oral nifedipine on pain and healing after hemorrhoidectomy. EASTERN JOURNAL OF MEDICINE. 2013;12:15–20.
MLA Thwayeb, Yousef. “Randomised Clinical Trial of Effect of Oral Nifedipine on Pain and Healing After Hemorrhoidectomy”. EASTERN JOURNAL OF MEDICINE, c. 12, sy. 1-2, 2013, ss. 15-20.
Vancouver Thwayeb Y. Randomised clinical trial of effect of oral nifedipine on pain and healing after hemorrhoidectomy. EASTERN JOURNAL OF MEDICINE. 2013;12(1-2):15-20.