Benign proctology
- Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review
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Angelina Di Re, James Wei Tatt Toh, Jonathan Iredell, Grahame Ctercteko
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Ann Coloproctol. 2020;36(1):5-11. Published online February 29, 2020
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DOI: https://doi.org/10.3393/ac.2020.01.08
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 Abstract
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- 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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Citations
Citations to this article as recorded by  - Role of antibiotics in Milligan-Morgan hemorrhoidectomy for Grade III to IV Hemorrhoids: A randomized clinical trial
Jiali Liu, Lei Lv, Hai-hua Qian, Ping-Liang Sun, Dan Zhang
Asian Journal of Surgery.2024; 47(1): 169. CrossRef - Topical metronidazole after haemorrhoidectomy to reduce postoperative pain: a systematic review
Chiara Eberspacher, Domenico Mascagni, Stefano Pontone, Francesco Leone Arcieri, Stefano Arcieri
Updates in Surgery.2024; 76(4): 1161. CrossRef - Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis
Juliana Jee, Lauren Vourneen O’Connell, Ishapreet Kaur, Shaheel Mohammad Sahebally
Digestive Surgery.2024; 41(4): 204. CrossRef - Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review
Varut Lohsiriwat, Romyen Jitmungngan
Medicina.2022; 58(3): 418. CrossRef - Topical Versus Oral Metronidazole After Excisional Hemorrhoidectomy: A Double-Blind Randomized Controlled Trial
Weisi Xia, Ahmed W.H. Barazanchi, Wiremu S. MacFater, Andrew D. MacCormick, Darren Svirskis, Tarik Sammour, Andrew G. Hill
Diseases of the Colon & Rectum.2022; 65(11): 1362. CrossRef - Treatment of Hemorrhoid in Unusual
Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef
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