title: A painless treatment for patients undergoing Milligan-Morgan haemorrhoidectomy.
abstract: BACKGROUND
  Postoperative pain associated with Milligan Morgan haemorrhoidectomy (MMH) remains problematic. Most patients complaint a severe pain on defecation and in the 1st postoperative week because of secondary infection and sphincter spasm. We studied the effect of metronidazole, lactulose and glyceryl-trinitrate on pain after MMH.
  
  
  METHODS
  Thirty patients were randomly assigned to two groups. The 1st received a treatment with oral laxative (lactulose 66.7%) metronidazole and a topical glyceryl-trinitrate ointment at 0.2% both pre and postoperative; the 2nd received a placebo at the same dosage. The amount of pain in the 1st week and at the time of two defecation, postoperative analgesic requirement and time to return to normal activities were documented.
  
  
  RESULTS
  A significant differences in the score pain on 2nd and 3rd day and on the 1st two defecation were observed among group. Analgesic consumption was highest in the placebo group.
  
  
  CONCLUSIONS
  The treatment with lactulose, metronidazole and topic glyceryl-trinitrate in patients undergoing MMH, seems to reduce secondary pain and increase patients satisfaction and earlier return to work with improvement of cost and benefit.
authors.affiliation: Università degli Studi di Palermo, Dipartimento di Discipline Chirurgiche ed Oncologiche, U.O. di Chirurgia Generale, Endoscopica, Diagnostica ed Interventistica, Italy. divitagaetano@libero.it
authors.forename: G
authors.initials: G
authors.lastname: Di Vita
authors.forename: R
authors.initials: R
authors.lastname: Patti
authors.forename: M
authors.initials: M
authors.lastname: Arcara
authors.forename: R
authors.initials: R
authors.lastname: Petrone
authors.forename: V
authors.initials: V
authors.lastname: Davì
authors.forename: P
authors.initials: P
authors.lastname: Leo
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007275:Injections, Intravenous; D007792:Lactulose / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000191:economics / Q000517:prevention & control*; D017060:Patient Satisfaction; D010919:Placebos; D013607:Tablets; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D005765:Gastrointestinal Agents; D010919:Placebos; D013607:Tablets; D014665:Vasodilator Agents; D008795:Metronidazole; D007792:Lactulose; D005996:Nitroglycerin