title: A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain.
abstract: OBJECTIVE
  Spasm of the internal anal sphincter plays a role in haemorrhoidal disease and may be a source of anal pain after haemorrhoid surgery. In this study, we investigated the effect of topical diltiazem (DTZ) on postoperative pain following Milligan-Morgan haemorrhoidectomy.
  
  
  METHODS
  After haemorrhoidectomy, 33 patients were randomly assigned to receive DTZ ointment (2%; n = 16) or a placebo ointment (n = 17). Ointments were applied to the perianal region three times daily for 7 days. A Visual Analogue Scale was used to assess postoperative pain. The primary end-point was reduction in postoperative pain.
  
  
  RESULTS
  Patients using the DTZ cream had significantly less pain and greater benefit than those in the placebo group throughout the first postoperative week, and total and daily narcotic analgesic use was higher in the placebo group. There were no differences in morbidity between the two groups.
  
  
  CONCLUSIONS
  Perianal application of DTZ cream after haemorrhoidectomy significantly reduces postoperative pain and is perceived as beneficial, with no increase in associated morbidity.
authors.affiliation: Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences Sina Hospital, Tehran University of Medical Sciences Sina Research Development Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: H A
authors.initials: HA
authors.lastname: Amoli
authors.forename: A Y
authors.initials: AY
authors.lastname: Notash
authors.forename: F J
authors.initials: FJ
authors.lastname: Shahandashti
authors.forename: A Y
authors.initials: AY
authors.lastname: Kenari
authors.forename: H
authors.initials: H
authors.lastname: Ashraf
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000627:therapeutic use; D004110:Diltiazem / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009824:Ointments / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D002121:Calcium Channel Blockers; D009824:Ointments; D004110:Diltiazem