title: Initial study to assess the effects of topical glyceryl trinitrate for pain after haemorrhoidectomy.
abstract: BACKGROUND
  Postoperative pain remains the most dreaded part of haemorrhoidectomy in the minds of both patients and doctors. It may delay patient discharge, recovery, and return to work. Glyceryl trinitrate has been used successfully in the treatment of anal fissures. We investigated its topical use in the management of pain after haemorrhoidectomy.
  
  
  METHODS
  Twenty patients were entered into a double-blind trial and randomised into two groups. Group A (n = 10) applied glyceryl trinitrate ointment (0.2% twice daily) to the perianal area following surgery, and Group B applied a placebo ointment. They applied the ointment for up to 42 days after surgery, or until they felt it necessary to stop the treatment. Patients scored their daily anal pain using a visual analogue scale. Six weeks after surgery, patients were reviewed by an independent observer.
  
  
  RESULTS
  The total pain score was calculated for each patient. The median score for Group A was 50.65; the median score for Group B was 73.50. There was no significant difference in pain scores between both groups, even when aberrant results were ignored. 20% of patients in each group complained that the ointment caused headache.
  
  
  CONCLUSIONS
  The results suggest that topical glyceryl trinitrate ointment may not significantly reduce postoperative pain following haemorrhoidectomy. Meta-analysis would provide a more definitive answer.
authors.affiliation: Department of Surgery, Greenwich District Hospital, Vanbrugh Hill, Greenwich, London, England.
authors.forename: C
authors.initials: C
authors.lastname: Elton
authors.forename: P
authors.initials: P
authors.lastname: Sen
authors.forename: A C
authors.initials: AC
authors.lastname: Montgomery
mesh_terms: D000287:Administration, Topical; D000368:Aged; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use*; D009824:Ointments; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D011184:Postoperative Period; D011336:Probability; D012016:Reference Values; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D009824:Ointments; D014665:Vasodilator Agents; D005996:Nitroglycerin