Is metronidazole a panacea for post-hemorrhoidectomy pain?

Neogi, Probal; Sinha, Anuvrat; Singh, Mohit

doi:10.18203/2349-2902.isj20184629

Cited by 4 publications

(10 citation statements)

References 4 publications

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“…In the trial of Al-Mulhim et al [14], 84% of metronidazole participants and 82% of control participants completed the study. In the study of Neogi et al [16] 87% of metronidazole participants and 95.2% of control participants completed the study. Neither of these trials analysed their data on an intention to treat basis.…”

Section: Discussionmentioning

confidence: 99%

“…While the differences in pain between the metronidazole and control groups were statistically significant across all time points, this difference was less than 1.0 on the VAS on 3 of the days (days 0, 1, and 2). Two of the trials [14,16] experienced some participant dropout, although the rates were acceptable. In the trial of Al-Mulhim et al [14], 84% of metronidazole participants and 82% of control participants completed the study.…”

Section: Discussionmentioning

confidence: 99%

“…The trial of Neogi et al [16] included patients with grades II, III and IV internal haemorrhoids. They did not report the oral metronidazole dose (duration was 7 days).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The Cochrane Risk of Bias Tool [11] was used to assess each of the studies and is summarised in Table 2. Overall, 3 out of 4 stud-ies [14][15][16] had high risk for bias. Only the study of Carapeti et al [3] study was double-blinded, with the rest having no blinding ( Table 2).…”

Section: Risk Of Biasmentioning

confidence: 99%

“…Both Carapeti et al [3] and Al-Mulhim et al [14] commented on the number of patients requiring additional analgesia -overall a reduction in the number of patients requiring additional analgesia was found favouring metronidazole (OR, 0.45; 95% CI, 0.24-0.83, P = 0.01). Ng et al [15] and Neogi et al [16] examined the actual number of additional analgesic tablets consumed. There was a trend toward fewer tablets consumed favouring metronidazole, but this did not reach statistical significance (MD, -3.04; 95% CI, -6.75 to 0.67; P = 0.11).…”

Section: Effect On Analgesia Consumptionmentioning

confidence: 99%

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Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review

Toh

Iredell

et al. 2020

Ann Coloproctol

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ReviewAnn Coloproctol 2020;36(1):5-11 https://doi.org/10. 3393/ac.2020.01.08 Purpose: Open haemorrhoidectomy is associated with significant postoperative pain. Metronidazole is commonly prescribed in the postoperative period as an adjunct to analgesia in pain management. Methods: In our systematic review, studies were identified using PubMed/MEDLINE, Embase/Ovid and Cochrane Register of Controlled Trials databases. Studies were included if they were randomised controlled trials (RCTs) involving interventions with oral metronidazole at any dose over any time period. The primary outcome was pain score (visual analogue scale, VAS) after open haemorrhoidectomy. Secondary outcomes included time to return to normal daily activities, additional analgesia usage, and postoperative complications. Results: Of 14 RCTs reviewed, 4 met inclusion criteria and were selected. The studies comprised 336 study subjects and 169 subjects were randomised to metronidazole while 167 were in the control group. There was a significant reduction in VAS across all time points, with maximal reduction seen on day 5 posthaemorrhoidectomy (mean difference, -2.28; 95% confidence interval, -2.49 to -2.08; P < 0.001). There was no difference in incidence of complications (P = 0.13). The Cochrane Risk of Bias Tool showed 3 of 4 of the studies had a risk of bias. Conclusion: Metronidazole may be associated with decreased pain but there is insufficient evidence from RCTs to provide a strong grade of recommendation. Further RCTs are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The trial of Neogi et al [16] included patients with grades II, III and IV internal haemorrhoids. They did not report the oral metronidazole dose (duration was 7 days).…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Section: Effect On Analgesia Consumptionmentioning

confidence: 99%

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Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review

Toh

Iredell

et al. 2020

Ann Coloproctol

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Topical metronidazole after haemorrhoidectomy to reduce postoperative pain: a systematic review

Eberspacher,

Mascagni,

Pontone

et al. 2024

Updates Surg

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Excisional haemorrhoidectomy is the gold standard for operating haemorrhoids, but it is accompanied by a significant problem: postoperative pain. Several strategies have been adopted to minimize this condition. Oral metronidazole has been proven to reduce postoperative pain but with some complications. This systematic review was conducted to investigate the effects and general efficacy of topical metronidazole administration and to evaluate its potential superiority over the oral formula. A systematic review of the literature was carried out. Randomized controlled trials published until September 2023 on PubMed, Central, and Web of Science were considered. The primary outcome considered was postoperative pain, which was evaluated using visual analogue scores. The secondary outcomes were analgesic use, return to work, and complications. Six randomized controlled trials were included, with a total of 536 patients. Topical metronidazole was compared with placebo in two studies, with oral formula in three studies, and with placebo and oral administration in one study. Topical metronidazole was found to be effective for treating postoperative pain when compared to a placebo but had no significant advantage over the oral formula. No complications were reported in the studies. Topical and oral metronidazole are effective solutions for postoperative pain after excisional haemorrhoidectomy. No superiority was demonstrated based on the route of administration, and complications were marginal for both formulas. Further studies are required to determine the best metronidazole solution.

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Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial

Abbas

Raza

Muhammad³

et al. 2020

Pak J Med Sci

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Background and Objectives: Milligan Morgan Hemorrhoidectomy is one of the most commonly performed surgeries. Post-operative pain is the major cause of morbidity in post hemorrhoidectomy patients. Metronidazole has an established role in relieving post hemorrhoidectomy pain. The objective was to evaluate the pain score by using topical and oral metronidazole in post Milligan Morgan hemorrhoidectomy patients. Methods: A prospective randomized controlled trail was done in surgical departments of Akbar Niazi Teaching Hospital, Islamabad. A total of 166 consecutive patients with 3rd and 4th degree hemorrhoids were presenting in surgical OPD and who underwent Milligan Morgan hemorrhoidectomy between July 2018 and December 2018 were included in the study. Patients allocated in two groups, Group-A received topical metronidazole 10% post hemorrhoidectomy for seven days and Group-B were given oral metronidazole 400mg for 07 days. Analgesics were given on patient’s requirement. Patients post hemorrhoidectomy pain was recorded by using VSA scale at baseline (1st day) and on 7th post-operative day. Data analysis was done by using SPSS 21. Pain calculated by compared in terms of mean, standard deviation between groups and independent sample T test was used. Association between demographic details like gender and ages of the patients with pain scale on 7th day was measured and chi-square distribution was used. Results: Total 166 patients were included in this study. The mean ages of the patients were 44.07±10.62 years with minimum 20 and maximum 60 years. Out of 166 patients, female were 55 (33.1%) and male were 111 (66.9%). Results showed significantly lower pain in patients using topical metronidazole as compared to oral metronidazole (p=0.001). Association of pain with respect to ages was insignificant (p=0.202) whereas between genders inside the groups showed significant difference (p=0.028). Conclusion: These results showed that topical metronidazole significantly reduces pain in post hemorrhoidectomy patients as compared to oral metronidazole overall and even when data stratified among age, gender and type of hemorrhoids. doi: https://doi.org/10.12669/pjms.36.5.1796 How to cite this:Abbas ST, Raza A, Chaudhry I, Hameed T, Hasham N, Arshad N. Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.1796 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Is metronidazole a panacea for post-hemorrhoidectomy pain?

Cited by 4 publications

References 4 publications

Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review

Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review

Topical metronidazole after haemorrhoidectomy to reduce postoperative pain: a systematic review

Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial

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