Meta-analysis of the use of glyceryl trinitrate ointment after haemorrhoidectomy as an analgesic and in promoting wound healing.
BACKGROUND
Glyceryl Trinitrate (GTN) ointment has been used to treat anal fissure and pain relief in haemorrhoids, but the value of its use post-haemorrhoidectomy as an analgesic and in wound healing is unclear. The side effect of headache has often been an associated problem. Therefore, a meta-analysis of randomised controlled trials was carried out investigating the role of GTN post-haemorrhoidectomy as an analgesic, its role in would healing and the unwanted incidence of headache.


METHODS
A structured literature search from 1966 to 2009, both paper and online, with no language barrier was carried out. 760 papers were identified and 5 randomised control trials which met the entry criteria were included in this study.


RESULTS
A total of 333 patients were included in the meta-analysis. The results revealed that GTN ointment was statistically significant in reducing pain on Day 3 and 7 compared to the placebo group. Day 3 shows a pain score of - 1.51 (p value of 0.029) and Day 7 by - 1.66 (p value of 0.014) respectively. However, it was not significant in reducing pain on Day 1. The Odds ratio for wound healing after GTN treatment at 3 weeks was 3.57 (P < 0.0001) when compared to the placebo group. Side effect of headache was not statistically significant.


CONCLUSIONS
This meta-analysis has shown that GTN ointment used post-haemorrhoidectomy has a significant analgesic effect in the intermediate time period (ie. Days 3-7). It also significantly improved wound healing at 3 weeks.
Ratnasingham
K
K
North Tees University Hospital, Hardwick Lane, Stockton on Tees, TS19 8, UK. Kumaran95@hotmail.com
Uzzaman
M
M
Andreani
S M
SM
Light
D
D
Patel
B
B
D000700:Analgesics / Q000627:therapeutic use*; D006261:Headache / Q000453:epidemiology; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D005996:Nitroglycerin / Q000627:therapeutic use*; D009824:Ointments; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D014945:Wound Healing
D000700:Analgesics; D009824:Ointments; D005996:Nitroglycerin