title: Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial.
abstract: BACKGROUND
  Hemorrhoidal disease occurs in 50% of people aged > 40 years and is the most common reason for anorectal surgery. Pain is the main complication. Multiple topical and systemic drugs have been investigated for pain control, but there is no ideal treatment. Metronidazole has been shown to decrease postoperative pain but is not used widely.
  
  
  OBJECTIVE
  To evaluate the effect of oral metronidazole versus placebo and to assess postoperative pain following hemorrhoidectomy.
  
  
  METHODS
  Controlled clinical trial in adult patients who underwent elective hemorrhoidectomy for grade III/IV hemorrhoids. Patients were assigned to receive metronidazole (500 mg q8 h orally; study group, SG) or placebo (control group, CG) for 7 days after surgery. Pain was assessed using a visual analog scale after surgery. Analgesic administration (time and use of analgesics) and resumption of daily life activities were also assessed.
  
  
  RESULTS
  Forty-four patients were included, 22 in each group. Postoperative pain differed significantly between the SG and CG at 6 h (3.86 ± 0.56, 6.64 ± 1.49), 12 h (5.59 ± 1.33, 8.82 ± 0.79), 24 h (6.86 ± 1.49, 9.73 ± 0.45), day 4 (5.32 ± 2.10, 9.50 ± 0.59), day 7 (3.14 ± 1.03, 7.36 ± 1.39), and day 14 (2.14 ± 0.46, 5.45 ± 1.29). The first analgesia dose was required at 21.27 ± 5.47 h in the CG and 7.09 ± 2.36 h in the SG (p < 0.05), the time of analgesic use was 6.86 ± 1.61 days in the CG and 13.09 ± 2.48 days in the SG (p < 0.05), and resumption of daily activities occurred at 7.59 ± 1.56 days in the CG and 14.73 ± 3.76 days in the SG (p < 0.05).
  
  
  CONCLUSIONS
  Oral administration of metronidazole is effective in pain management after hemorrhoidectomy.
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: Sergio
authors.initials: S
authors.lastname: Solorio-López
authors.affiliation: Servicio de Coloproctología, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: Ulises Rodrigo
authors.initials: UR
authors.lastname: Palomares-Chacón
authors.affiliation: Servicio de Coloproctología, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: Jesús Enrique
authors.initials: JE
authors.lastname: Guerrero-Tarín
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: Alejandro
authors.initials: A
authors.lastname: González-Ojeda
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Cortés-Lares
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rendón-Félix
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: Jesús
authors.initials: J
authors.lastname: García-Rentería
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: Mariana
authors.initials: M
authors.lastname: Chávez-Tostado
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, Mexico.
authors.forename: Lizbeth Araceli
authors.initials: LA
authors.lastname: Cuesta-Márquez
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: Marcela
authors.initials: M
authors.lastname: Salazar-Parra
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México.
authors.forename: Clotilde
authors.initials: C
authors.lastname: Fuentes Orozco
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D061865:Hemorrhoidectomy / Q000009:adverse effects* / Q000379:methods; D006484:Hemorrhoids / Q000601:surgery; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D008795:Metronidazole