Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials
Summary: 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...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2018-09-01
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| Series: | Asian Journal of Surgery |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958417301495 |
| _version_ | 1828923679078088704 |
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| author | Yan-Jiun Huang Chien-Yu Chen Ray-Jade Chen Yi-No Kang Po-Li Wei |
| author_facet | Yan-Jiun Huang Chien-Yu Chen Ray-Jade Chen Yi-No Kang Po-Li Wei |
| author_sort | Yan-Jiun Huang |
| collection | DOAJ |
| description | Summary: 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. Keywords: Hemorrhoidectomy, Post-hemorrhoidectomy, Diltiazem ointment, Calcium channel blocker, Meta-analysis |
| first_indexed | 2024-12-13T22:43:31Z |
| format | Article |
| id | doaj.art-ddad02c63c544b779cf969fbd12171ed |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-12-13T22:43:31Z |
| publishDate | 2018-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-ddad02c63c544b779cf969fbd12171ed2022-12-21T23:28:48ZengElsevierAsian Journal of Surgery1015-95842018-09-01415431437Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trialsYan-Jiun Huang0Chien-Yu Chen1Ray-Jade Chen2Yi-No Kang3Po-Li Wei4Division 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, TaiwanDepartment of Anesthesiology, Taipei Medical University Hospital, Taipei, TaiwanDivision of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, TaiwanCenter for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei Medical University, Taipei, TaiwanDivision 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; Corresponding author. Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Sinyi District, Taipei, 11031, Taiwan.Summary: 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. Keywords: Hemorrhoidectomy, Post-hemorrhoidectomy, Diltiazem ointment, Calcium channel blocker, Meta-analysishttp://www.sciencedirect.com/science/article/pii/S1015958417301495 |
| spellingShingle | Yan-Jiun Huang Chien-Yu Chen Ray-Jade Chen Yi-No Kang Po-Li Wei Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials Asian Journal of Surgery |
| title | Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials |
| title_full | Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials |
| title_fullStr | Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials |
| title_full_unstemmed | Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials |
| title_short | Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials |
| title_sort | topical diltiazem ointment in post hemorrhoidectomy pain relief a meta analysis of randomized controlled trials |
| url | http://www.sciencedirect.com/science/article/pii/S1015958417301495 |
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