Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial

• Published in: Revista española de enfermedades digestivas Vol. 107; no. 11; pp. 681 - 685
• Main Authors: Solorio-López, Sergio, Palomares-Chacón, Ulises Rodrigo, Guerrero-Tarín, Jesús Enrique, González-Ojeda, Alejandro, Cortés-Lares, José Antonio, Rendón-Félix, Jorge, García-Rentería, Jesús, Chávez-Tostado, Mariana, Cuesta-Márquez, Lizbeth Araceli, Salazar-Parra, Marcela, Fuentes Orozco, Clotilde
• Format: Journal Article
• Language: English
• Published: Spain Sociedad Española de Patología Digestiva 01-11-2015; Aran Ediciones
• Subjects: Adult; Aged; Dolor postoperatorio; Female; Gastroenterology & Hepatology; Geriatrics & Gerontology; Hemorrhoidectomy - adverse effects; Hemorrhoidectomy - methods; Hemorrhoids - surgery; Hemorroidectomía; Humans; Infectious Diseases; Male; Metronidazol; Metronidazole - therapeutic use; Middle Aged; Oncology; Pain Measurement; Pain, Postoperative - drug therapy; Pathology; Pharmacology & Pharmacy; Prospective Studies; Radiology, Nuclear Medicine & Medical Imaging; Surgery; Hemorroidectomía; Postoperative pain; Metronidazol; Metronidazole; Dolor postoperatorio; Hemorrhoidectomy
• ISSN: 1130-0108
• DOI: 10.17235/reed.2015.3926/2015

Hemorrhoidal disease occurs in 50% of people aged > 40 years and is the most common reason for anorectal surgery. Pain is the main complication. Multiple topical and systemic drugs have been investigated for pain control, but there is no ideal treatment. Metronidazole has been shown to decrease postoperative pain but is not used widely.
To evaluate the effect of oral metronidazole versus placebo and to assess postoperative pain following hemorrhoidectomy.
Controlled clinical trial in adult patients who underwent elective hemorrhoidectomy for grade III/IV hemorrhoids. Patients were assigned to receive metronidazole (500 mg q8 h orally; study group, SG) or placebo (control group, CG) for 7 days after surgery. Pain was assessed using a visual analog scale after surgery. Analgesic administration (time and use of analgesics) and resumption of daily life activities were also assessed.
Forty-four patients were included, 22 in each group. Postoperative pain differed significantly between the SG and CG at 6 h (3.86 ± 0.56, 6.64 ± 1.49), 12 h (5.59 ± 1.33, 8.82 ± 0.79), 24 h (6.86 ± 1.49, 9.73 ± 0.45), day 4 (5.32 ± 2.10, 9.50 ± 0.59), day 7 (3.14 ± 1.03, 7.36 ± 1.39), and day 14 (2.14 ± 0.46, 5.45 ± 1.29). The first analgesia dose was required at 21.27 ± 5.47 h in the CG and 7.09 ± 2.36 h in the SG (p < 0.05), the time of analgesic use was 6.86 ± 1.61 days in the CG and 13.09 ± 2.48 days in the SG (p < 0.05), and resumption of daily activities occurred at 7.59 ± 1.56 days in the CG and 14.73 ± 3.76 days in the SG (p < 0.05).
Oral administration of metronidazole is effective in pain management after hemorrhoidectomy.