Comparison of topical anesthetic cream (EMLA) and diclofenac suppository for pain relief after hemorrhoidectomy: a randomized clinical trial.
OBJECTIVE
We compared the efficacy and side effects of diclofenac and a topical eutectic mixture of local anesthetics (EMLA) for pain relief after hemorrhoidectomy.


METHODS
Ninety patients, nominated for elective hemorrhoidectomy, were recruited for this randomized clinical trial and were randomly categorized into three groups (30 patients in each group). After surgery, the patients in the first group received one 100 mg diclofenac suppository, those in the second group received 5 g of EMLA, and those in the third group received 5 g of petrolatum ointment (control group). The pain intensity was measured using a visual analog scale (VAS). Twenty-five mg of intramuscular pethidine was administered upon the patient's request. Pain measurements were performed on the patient's transfer to the recovery ward, 2 h after surgery, the evening and the morning after surgery.


RESULTS
The EMLA group yielded the lowest VAS score on transfer to recovery and at 2 h after surgery (p < 0.05). The diclofenac group reported the lowest VAS score in the evening and the morning after surgery (p < 0.05).


CONCLUSIONS
Topical use of an EMLA cream is appropriate for short-term pain control following hemorrhoidectomy, while diclofenac yields a more sustainable pain control.
Department of Anesthesiology, Imam Hospital, Tehran University of Medical Sciences, Keshavarz Blvd, Vali Asr Square, Tehran, Iran. mrahimi_anesth@yahoo.com
Mojgan
M
Rahimi
Ali Reza
AR
Kazemeini
Nasim
N
Pourtabatabaei
Amir Reza
AR
Honarmand
D000287:Administration, Topical; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D004008:Diclofenac / Q000008:administration & dosage*; D005260:Female; D061865:Hemorrhoidectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D063465:Skin Cream; D013488:Suppositories
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D004008:Diclofenac