title: Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study.
abstract: BACKGROUND
  Conventional haemorrhoidectomy (CH) is well known to cause significant post-operative pain and delayed return to daily activities. Both surgical wounds and sphincterial apparatus spasms are likely responsible for the pain. In this study, we evaluated the role of glyceryl trinitrate ointment (GTN) in reducing post-operative pain, ameliorating wound healing and recovery after CH.
  
  
  METHODS
  Between 01/08 and 12/11, 203 patients with symptomatic haemorrhoids were enrolled in the study and received (103 patients) or not (100 patients) 0.4 % GTN ointment for 6 weeks after surgery. Pain was assessed using a 10-cm linear visual analogue scale (VAS). Data on post-operative pain, wound secretion and bleeding, return to normal activities and complications were recorded. Data were analysed using Fisher's exact and Mann-Whitney tests.
  
  
  RESULTS
  GTN-treated group experienced significantly less pain during the first week after surgery (p < 0.0001). This difference was more evident starting from post-operative day 4 (p < 0.0001). A significant higher percentage of untreated patients experienced severe pain (mean VAS score > 7) (10 % vs 31 %). There were significant differences in terms of secretion time (p = 0.0052) and bleeding time (p = 0.02) in favor of GTN. In addition, the duration of itching was less in the GTN group (p = 0.0145). Patients treated with GTN were able to an early return to daily activities compared to untreated (p < 0.0001). Fifteen GTN-treated patients (14.6 %) discontinued the application because of local discomfort and headache.
  
  
  CONCLUSIONS
  GTN ointment enhances significantly post-operative recovery, reducing pain in terms of duration and intensity. This effect might be secondary to a faster wound healing expressed by reduced secretion, bleeding and itching time.
authors.affiliation: Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Franceschilli
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Ugo
authors.forename: Elisabetta
authors.initials: E
authors.lastname: de Luca
authors.forename: Federica
authors.initials: F
authors.lastname: Cadeddu
authors.forename: Giovanni
authors.initials: G
authors.lastname: Milito
authors.forename: Nicola
authors.initials: N
authors.lastname: di Lorenzo
authors.forename: Achille L
authors.initials: AL
authors.lastname: Gaspari
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sileri
mesh_terms: D000328:Adult; D000368:Aged; D003710:Demography; D005260:Female; D061865:Hemorrhoidectomy / Q000009:adverse effects; D006484:Hemorrhoids / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D009824:Ointments / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000209:etiology; D011182:Postoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
chemical_list: D009824:Ointments; D005996:Nitroglycerin