Glyceryl Trinitrate Ointment Did Not Reduce Pain After Stapled Hemorrhoidectomy: A Randomized Controlled Trial

Abstract

Medications, including topical 0.2% glyceryl trinitrate (GTN), can reduce anal spasm and pain after excisional hemorrhoidectomy. GTN after stapled hemorrhoidopexy was compared with routine postoperative management. Patients with symptomatic grade 3/4 hemorrhoids were recruited. After stapled hemorrhoidopexy, residual perianal skin tags were excised as appropriate. Those requiring double purse-string mucosectomy were excluded. Postoperative pain, pain duration, and complications were assessed. One hundred ten patients (74 men; mean age 50.6 years) were enrolled in the control group and 100 patients (57 men; mean age 49.8 years) in the GTN group. Maximum pain was higher in the GTN group (P = 0.015). There were no differences between the two groups in residual perianal skin tags requiring excision, postoperative complications, recurrence rates, follow-up period, average pain, duration of pain, or satisfaction scores. Sixteen GTN patients were noncompliant due to side effects. None had persistent perianal skin tags. GTN did not reduce postoperative pain after stapled hemorrhoidectomy.

Is the severe pain after Milligan-Morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? A case series of 117 consecutive patients

“…Several strategies have been proposed: acupuncture [7], creams or gels with several agents (nitrites, anesthetics, calcium antagonists, sucralfate, metronidazole, salsobromoiodic, cholestyramine) for topical application [8], [9], [10], [11], [12], [13], [14], [15], nonsteroidal anti-inflammatory suppositories [11], local infiltration with botulinum toxin [16], or local anesthetic agents [5], [6], [17] or even ambulatory PCA (patient controlled analgesia) pumps [18].…”

Is Stapled Hemorrhoidectomy a Safe Procedure for Third and Fourth Grade Hemorrhoids? An Experience at Civil Hospital Karachi

“…Hemorrhoids are actually anal cushions that turn into pathological state, and they may present with anal bleeding, pain, and something coming out from the anus [1].…”

“…Hemorrhoids are amongst the most frequent anorectal conditions affecting approximately 4-36 % of the general population [1,2]. Hemorrhoids are actually anal cushions that turn into pathological state, and they may present with anal bleeding, pain, and something coming out from the anus [1].…”

Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

“…A recent randomized trial confirmed these results [29]. However, this benefit was not confirmed after stapled hemorrhoidopexy [30]. Injected botulinum showed superior efficacy compared to glyceryl trinitrate ointment [31].…”