Pre‐emptive analgesia and metronidazole on post‐haemorrhoidectomy pain control

Abstract

Background: Post‐haemorrhoidectomy wound pain is often the focus of concern for patients as well as their clinicians. Despite the recent enthusiasm brought about by stapled haemorrhoidectomy, conventional haemorrhoidectomy still remains the mainstay of surgical treatment for symptomatic third and fourth degree haemorrhoids in places where healthcare funding cannot afford these expensive devices. The present study aims at evaluating the effectiveness of pre‐emptive analgesia and oral metronidazole in reducing wound pain and complications after open haemorrhoidectomy. Method: Patients with symptomatic third or fourth degree haemorrhoids undergoing open haemorrhoidectomy were randomized into four groups. Group 1 received pre‐emptive analgesia (0.5% bupivacaine). Group 2 received oral metronidazole (400 mg three times daily for 1 week). Group 3 received both treatments while group 4 was the control group. Results: Number of patients recruited was 105. There was no significant difference among the four groups in terms of pain scores on the first three postoperative days, analgesic requirements, hospital stay and the time to return to normal daily activities. Patients who received oral metronidazole had significantly less pain at the time of the first bowel motion ( P = 0.037). Conclusion: Oral metronidazole significantly reduces pain during the first bowel motion after open haemorrhoidectomy. Pre‐emptive analgesia with 0.5% bupivacaine does not reduce postoperative pain.