Systematic review and meta‐analysis of the role of metronidazole in post‐haemorrhoidectomy pain relief

Lyons, Nicholas; Cornille, J B; Pathak, Samir; Charters, Pia; Daniels, Ian R.; Smart, Neil J.

doi:10.1111/codi.13755

Cited by 30 publications

(31 citation statements)

References 28 publications

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“…We agree with Lyons et al .’s recent systematic review that concluded that metronidazole does reduce pain significantly following haemorrhoidectomy. Although they had similar methodology to ours, we disagree with the inclusion of one paper that included GTN with metronidazole in the intervention group as GTN has been shown to independently reduce pain .…”

Section: Resultssupporting

confidence: 91%

Metronidazole following excisional haemorrhoidectomy: a systematic review and meta‐analysis

Xia

Manning

Barazanchi

et al. 2018

ANZ Journal of Surgery

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Section: Resultssupporting

confidence: 91%

Metronidazole following excisional haemorrhoidectomy: a systematic review and meta‐analysis

Xia

Manning

Barazanchi

et al. 2018

ANZ Journal of Surgery

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“…The use of oral metronidazole in controlling postoperative pain was recently evaluated in two meta-analysis with conflicting results [186,187].…”

Section: Bleeding: Fewer People Have Postoperative Bleeding After Thdmentioning

confidence: 99%

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

et al. 2020

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Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication. The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE. These guidelines are inclusive and not prescriptive. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C.

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“…There have been 3 systematic reviews [20][21][22] published in recent years assessing the analgesic effects of metronidazole in posthaemorrhoidectomy patients. While these reviews have pooled more patients, all 3 reviews included both open and closed haemorrhoidectomies, which is not generalizable to open haemorrhoidectomy alone.…”

Section: Discussionmentioning

confidence: 99%

“…However, on subanalysis they did find lower reported pain scores on day 1 (standardised mean difference [SMD], -0.87 ± 0.44; 95% CI, -1.73 to -0.015; P = 0.046) and day 4 (SMD, -1.43 ± 0.71; 95% CI, -2.83 to -0.037; P = 0.044). The other 2 systematic reviews [21,22] reported a significant decrease in pain associated with metronidazole use. One review [21] performed a meta-analysis on days 1, 7, and 14; the other review [22] assessed pain on days 1, 2, and 7.…”

Section: Discussionmentioning

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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Systematic review and meta‐analysis of the role of metronidazole in post‐haemorrhoidectomy pain relief

Abstract: Metronidazole is a cheap, safe and effective intervention for reducing postoperative pain following conventional haemorrhoidectomy.

Cited by 30 publications

References 28 publications

Metronidazole following excisional haemorrhoidectomy: a systematic review and meta‐analysis

Metronidazole following excisional haemorrhoidectomy: a systematic review and meta‐analysis

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

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

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