title: Comparison of internal sphincterotomy with topical diltiazem for post-hemorrhoidectomy pain relief: a prospective randomized trial.
abstract: OBJECTIVE
  To assess the efficacy of internal sphincterotomy compared with application of topical 2% Diltiazem ointment after hemorrhoidectomy for pain relief.
  
  
  METHODS
  Prospective randomized study.
  
  
  METHODS
  In an 18-month period, 108 subjects with uncomplicated Grade 3/ 4 hemorrhoids were enrolled in the study and were randomized into two equal groups: Subjects in Group A underwent internal sphincterotomy at time of primary surgery while those in Group B received 1 g of 2% Diltiazem ointment locally, thrice daily for seven days. Postoperative pain perception was measured using visual analog score (VAS) and on the basis of number of analgesic tablets (Tab tramadol 50 mg) required in each group. Time to discharge, time to return to work and incidence of complications measured and compared.
  
  
  METHODS
  Statistical techniques applied were Student T test, Chi-square and Fisher's Exact Test.
  
  
  RESULTS
  There were 102 analyzable subjects (Group A: 50 and Group B: 52). The mean VAS score was significantly less in the internal sphincterotomy group from the fourth postoperative day onwards compared to topical Diltiazem (2.23 vs. 3.72; P =0.031). Similarly, the mean requirement of analgesic tablets [10.54 vs. 15.40; P =0.01] was much lower in Group A. There was no significant difference in terms of time to discharge and time to return to work between the two groups. The incidence of complications was more with the internal sphincterotomy group (11.5% vs. 3 %; P =0.488).
  
  
  CONCLUSIONS
  In patients undergoing hemorrhoidectomy, addition of surgical internal sphincterotomy results in lesser pain in the postoperative period as compared to those receiving topical application of Diltiazem.
authors.affiliation: Department of Oncosurgery, Army Hospital (R and R), Delhi Cantt, Delhi 110 010, India. bolubonkey@rediffmail.com
authors.forename: A
authors.initials: A
authors.lastname: Chauhan
authors.forename: S
authors.initials: S
authors.lastname: Tiwari
authors.forename: V K
authors.initials: VK
authors.lastname: Mishra
authors.forename: P K
authors.initials: PK
authors.lastname: Bhatia
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004110:Diltiazem / Q000627:therapeutic use*; D005260:Female; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009824:Ointments / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D014147:Tramadol / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D002121:Calcium Channel Blockers; D009824:Ointments; D014147:Tramadol; D004110:Diltiazem