Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.
Asian J Surg. 2018 Sep;41(5):431-437. doi: 10.1016/j.asjsur.2017.06.002. Epub 2017 Jul 8.
Hemorrhoidectomy is commonly associated with postoperative pain. Calcium channel blockers are known to cause relaxation of gastrointestinal smooth muscle and oral diltiazem has also been shown to reduce the resting anal pressure.
We attempted to analyze efficacy and side effects of topical diltiazem oint. in post-operative pain control.
This is a meta-analysis of patients who underwent hemorrhoidectomy using topical diltiazem oint. versus placebo (Vaseline) for pain control. Patients with third or fourth degree hemorrhoids undergoing traditional hemorrhoidectomy were included. Procedures took place in the colorectal division of a hospital in 5 countries. Five randomized control trials (RCTs) published between 2005 and 2016 including 227 patients were included our meta-analysis (Diltiazem (calcium channel block) group = 137; Placebo (Vaseline) group = 90). Pain assessment was performed using a standardized Visual Analogue Scale. Any side effects of surgery or medication use, which were noted by the patient or the surgeon, also were recorded.
A total of 227 patients were included in the meta-analysis. The results revealed that Diltiazem ointment was statistically significant in reducing pain within 48 h, at 72 h, and more than 96 h after operation compared to the placebo group. Regarding overall complications (including headache), there was no statistical significance between diltiazem and placebo group.
Topical application of diltiazem effectively relieves pain after hemorrhoidectomy with minimal side effects. Further large studies are needed to substantiate its value in clinical practice.
痔切除术通常与术后疼痛有关。钙通道阻滞剂已知可引起胃肠道平滑肌松弛，口服地尔硫卓也已显示可降低静息肛门压力。
我们试图分析局部地尔硫卓软膏在术后疼痛控制中的疗效和副作用。
这是一项对接受痔切除术的患者使用局部地尔硫卓软膏与安慰剂（凡士林）进行疼痛控制的荟萃分析。纳入接受传统痔切除术的第三或第四度痔患者。该手术在 5 个国家的一家医院的结肠直肠科进行。纳入我们荟萃分析的是 5 项发表于 2005 年至 2016 年之间的随机对照试验（RCT），共包括 227 名患者（地尔硫卓（钙通道阻滞剂）组 137 例；安慰剂（凡士林）组 90 例）。疼痛评估采用标准化视觉模拟量表进行。患者或外科医生记录任何手术或药物使用的副作用。
共有 227 名患者纳入荟萃分析。结果表明，与安慰剂组相比，地尔硫卓软膏在术后 48 小时、72 小时和 96 小时以上时，在减轻疼痛方面具有统计学意义。关于总体并发症（包括头痛），地尔硫卓组与安慰剂组之间无统计学意义。
局部应用地尔硫卓可有效缓解痔切除术后疼痛，副作用最小。需要进一步的大型研究来证实其在临床实践中的价值。
