Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials.

Yan-Jiun Huang, Chien-Yu Chen, Ray-Jade Chen, Yi-No Kang, Po-Li Wei

Journal: Asian journal of surgery 2019;41(5):431-437

PMID: 28698000

Free Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Hemorrhoidectomy is commonly associated with postoperative pain. Calcium channel blockers are known to cause relaxation of gastrointestinal smooth muscle and oral diltiazem has also been shown to reduce the resting anal pressure.

OBJECTIVE

We attempted to analyze efficacy and side effects of topical diltiazem oint. in post-operative pain control.

METHODS

This is a meta-analysis of patients who underwent hemorrhoidectomy using topical diltiazem oint. versus placebo (Vaseline) for pain control. Patients with third or fourth degree hemorrhoids undergoing traditional hemorrhoidectomy were included. Procedures took place in the colorectal division of a hospital in 5 countries. Five randomized control trials (RCTs) published between 2005 and 2016 including 227 patients were included our meta-analysis (Diltiazem (calcium channel block) group = 137; Placebo (Vaseline) group = 90). Pain assessment was performed using a standardized Visual Analogue Scale. Any side effects of surgery or medication use, which were noted by the patient or the surgeon, also were recorded.

RESULTS

A total of 227 patients were included in the meta-analysis. The results revealed that Diltiazem ointment was statistically significant in reducing pain within 48 h, at 72 h, and more than 96 h after operation compared to the placebo group. Regarding overall complications (including headache), there was no statistical significance between diltiazem and placebo group.

CONCLUSIONS

Topical application of diltiazem effectively relieves pain after hemorrhoidectomy with minimal side effects. Further large studies are needed to substantiate its value in clinical practice.

Address: Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.; Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.; Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Cancer Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Translational Laboratory, Department of Medical Research, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan. Electronic address: [email protected].

DOI: 10.1016/j.asjsur.2017.06.002