Botulinum Toxin vs. Topical Glyceryl Trinitrate Ointment for Pain Control in Patients Undergoing Hemorrhoidectomy: A Randomized Trial

Abstract

A single intrasphincter injection of botulinum toxin was more effective and safer than repeated applications of glyceryl trinitrate in reducing early postoperative pain at rest but not during defecation.

Botulinum toxin reduces anal spasm but has no effect on pain after haemorrhoidectomy

“…In the latest study by Patti et al. comparing botulinum toxin and topical nitrate, the authors did not mention the routine use of postoperative metronidazole [11]. Furthermore in this study there was no control group.…”

“…Interestingly, in a further study by Patti et al. , the reduction in MRP was still present at day 40 [11]. Brisinda et al.…”

A randomized, prospective, double‐blind, placebo‐controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain

“…In the studies by Elton et al [6] and Tan et al [4], GTN (0.2%) ointment did not reduce pain after haemorrhoidectomy. Previous results in respect of the effect of botulinum toxin, another agent used as chemical sphincterotomy, on pain following haemorrhoidectomy are also controversial [17,18]. Additionally, injection of botulin toxin was not popular among surgeons, especially in light of some associated complications.…”

“…Additionally, injection of botulin toxin was not popular among surgeons, especially in light of some associated complications. It is expensive, often painful and may lead to perianal sepsis, thrombosis or faecal incontinence, which persists until there has been local neuronal regeneration [17,18].…”

Management of haemorrhoids

“…In addition to perioperative local anaesthetics and analgesics, laxatives help to reduce pain during the first postoperative motion. Prophylactic oral metronidazole, 18 topical diltiazem, 19 topical glyceryl trinitrate, or injected botulinum toxin 20 have marginal benefit in reducing pain after surgery. Complications include secondary haemorrhage (seven to 10 days after surgery), urinary retention, infection, faecal incontinence as a result of sphincter damage, and anal stenosis-usually as a result of inadequate mucosal bridges.…”