ROLE OF POST-OP TOPICAL DILTIAZEM CREAM IN PAIN CONTROL AFTER MILLIGAN-MORGAN HEMORRHOIDECTOMY

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Abstract

ABSTRACT
Background: Spasm of internal anal sphincter is thought to be responsible for pain after hemorrhoidectomy. Topical
use of a calcium channel blocker, 2% Diltiazem (DTZ), may be effective in reducing pain after hemorrhoidectomy.
Objective: To evaluate and compare pain scores on Visual Analogue Scale post-operatively after hemorrhoidectomy
from day two to day five, in patients using 2% DTZ versus patients using Placebo ointment along with standard treatment
for pain relief. Need for urinary catheterization was also assessed indicating severity of pain causing urinary retention.
Materials and Methods: This was a randomized control trial conducted at Hayatabad Medical Complex, Peshawar,
for a period of fourteen months from 01st June 2016 to 31st August, 2017. One hundred patients, who had undergone
Milligan Morgan hemorrhoidectomy, were randomly assigned to receive 2% DTZ ointment (Group A - study Group)
or a placebo ointment-petroleum jelly (Group B - control group) post-operatively. Fifty patients were included in each
group. Postoperative pain scores were recorded using Visual Analogue Score on second postoperative day. SPSS
version 16 was used for statistical analysis.
Results: Mean age was 35.1 ±13.3years. 64(64%) patients were males whereas thirty six (36%) were females, with male
to female ratio being 1.7:1. Patients using 2% DTZ ointment had significantly less pain after surgery. The best pain relief
in range of 1-3 on Visual Analogue Scale was achieved in 36% patients in group-A(Study Group) while the same score
was achieved by only 12% of patients in group-B(Control Group).Urinary retention because of severe pain occurred
only in 2 patients(0.4%) in group-A while it occurred in 6 patients(12%) in group-B, for which catheterization was done.
Conclusion: Perianal application of 2% Diltiazem ointment after hemorrhoidectomy is effective in reducing pain
post-operatively.
Key Words: Hemorrhoidectomy, Calcium Channel Blockers, Diltiazem, Milligan Morgan Hemorrhoidectomy

Authors: 
Rashid Aslam2
Zeeshan Saboor Ahmed
Nayab Iqbal
Tasmia,
Aneela Khan
Muhammad Fawad Khan
Fida Hussain
Journal Issue: 

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