Abstract

Introduction: Pain is almost a constant feature after hemorrhoidectomy and is the commonest reason for delayed patient discharge [1]. 0.2% 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, we designed this study to evaluate the analgesic effects of local application of 0.2% GTN for pain management after hemorrhoidectomy, and its role in would healing and the unwanted incidence of headache.
Materials & Methods: A randomized, single blinded trial was carried out over a period of six months. 100 patients were recruited and randomized to receive either 0.2% GTN or polymyxin ointment. Patients with comorbidities that contraindicate the use of 0.2% GTN were excluded from the study. Inferential and descriptive statistics were calculated      using SPSS version 10.0
Results: 100 patients were recruited and divided into 2 equal groups of 50 patients each. One group received 0.2% GTN and the other 50 patients received polymyxin ointment. There was no statistically significant difference noted in gender, age and degree of haemorrhoids. Pain perception was also statistically insignificant in both the groups, however, a significant number of patients (33 out of 50) showed complete wound healing at the end of 4th week of surgery in the group receiving 0.2% GTN. This was a statistically significant finding (p=0.004). None of the patients in polymyxin group experienced headaches but this was observed in 5 patients (10%) who received 0.2% GTN, but this was statistically insignificant (p=0.317) and did not warrant the discontinuation of 0.2% GTN in the group.
Conclusion: 0.2% GTN ointment significantly enhances the 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.