Comparative Study of Placebo Versus Metronidazole as a Role of Pain Relief Post Hemorrhoidectomy

Abstract

Background: After hemorrhoidectomy, patients often experience pain, which is a difficult issue to manage post-surgery despite excisional hemorrhoidectomy being a primary treatment for severe and complex hemorrhoids.

Objective: To assess the role of metronidazole versus placebo in terms of pain relief post hemorrhoidectomy.

Study design and setting: This randomized control trial was done at the general surgery department of Jinnah Postgraduate Medical College, karachi

Study duration: From January 2022 to July 2022

Methods: All the patients, ages 18–60, of both genders who underwent surgeries for grade III and grade IV hemorrhoids were included. The study assigned patients into two groups - a control group and a group that received oral metronidazole for seven days after the post operatively. Both groups were given a standardized post-operative analgesic treatment. VAS was used to measure the post-operative pain and its severity. All the data was collected via a study proforma, and SPSS version 26 was used for the data analysis.

Results: A total of 60 cases of hemorrhoids were comparatively studied; mean age of the case group was 39.36+10.43 years and the mean age of the control group was 35.33+9.35 years (p=0.120).  The mean BMI and average disease duration was statistically insignificant according to both groups (p > 0.05). In the cases group, grade III hemorrhoids were 36.7% and grade IV hemorrhoids were 63.3%, while in the control group, grade III hemorrhoids were 46.7% and grade IV hemorrhoids were 53.3% (p=0121). The mean operative time was almost similar in both groups (p=0.515). Average VAS was significantly decreased in the case group after 2 hours, at 24 hours, at 36 hours, and at 48 hours (p=<0.05), while it was statistically insignificant according to both groups at the 7^th post-operative day (p=0.091).

Conclusion: The use of oral or topical metronidazole in the post-operative period concludes to be more effective in terms of clinically significant early pain relief.