COMPARISON OF POST-OPERATIVE PAIN WITH TOPICAL GLYCERYL TRINITRATE CREAM VERSUS LATERAL INTERNAL ANAL SPHINCTEROTOMY AFTER HEMORRHOIDECTOMY

Abstract

Background: Hemorrhoidectomy is the surgical treatment for grade III, IV hemorrhoids. Hemorrhoidectomy is notorious for
postoperative pain which may be due to spasm of the internal anal sphincter.

Objective: To compare mean post-operative pain with 0.2% topical Glyceryl Trinitrate cream versus lateral internal anal sphincterotomy after hemorrhoidectomy.

Methodology: Setting: General Surgery ward, Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Duration: From 4th February to 4th August, 2015. Design: Randomized Controlled Trials. A total of 60 patients with hemorrhoids were included in this study. Thirty patients were in group A and subjected to Milligan-Morgan open hemorrhoidectomy followed by post-operative application of 0.2% topical Glyceryl Trinitrate (GTN) using a measuring spoon, three times a day. 30 patients were included in group B and treated with Milligan-Morgan open hemorrhoidectomy along with lateral internal sphincterotomy. All the patients were followed up to one week for post-operative pain assessment and mean post-operative pain was noted for both groups at 7th day postoperatively. This all data was recorded on an especially designed Proforma. The data was entered in SPSS version 16 and
analyzed. Results: Mean post-operative pain score was significantly low in group B (2.07±0.9) as compared to group A
(3.17±1.1) (p=0.0005). Conclusion: Internal sphincterotomy with open hemorrhoidectomy is an effective method to reduce posthemorrhoidectomy pain as compared to 0.2% topical Glyceryl Trinitrate (GTN) cream.