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Re AD, Toh JWT, Iredell J, et al. Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review. Ann Coloproctol. 2020;36(1):5-11doi: 10.3393/ac.2020.01.08.
Re, A. D., Toh, J. W. T., Iredell, J., & Ctercteko, G. (2020). Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review. Annals of coloproctology, 36(1), 5-11. https://doi.org/10.3393/ac.2020.01.08
Re, Angelina Di, et al. "Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review." Annals of coloproctology vol. 36,1 (2020): 5-11. doi: https://doi.org/10.3393/ac.2020.01.08
Re AD, Toh JWT, Iredell J, Ctercteko G. Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review. Ann Coloproctol. 2020 Feb;36(1):5-11. doi: 10.3393/ac.2020.01.08. Epub 2020 Feb 29. PMID: 32146782; PMCID: PMC7069672.
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Ann Coloproctol. 2020 Feb;36(1):5-11. doi: 10.3393/ac.2020.01.08. Epub 2020 Feb 29.

Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review.

Annals of coloproctology

Angelina Di Re, James Wei Tatt Toh, Jonathan Iredell, Grahame Ctercteko

Affiliations

  1. Division of Surgery and Anaesthetics, Colorectal Department, Westmead Hospital, Westmead, Australia.
  2. The University of Sydney, Westmead Hospital, Westmead, Australia.
  3. Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia.

PMID: 32146782 PMCID: PMC7069672 DOI: 10.3393/ac.2020.01.08

Abstract

PURPOSE: Open haemorrhoidectomy is associated with significant postoperative pain. Metronidazole is commonly prescribed in the postoperative period as an adjunct to analgesia in pain management.

METHODS: In our systematic review, studies were identified using PubMed/MEDLINE, Embase/Ovid and Cochrane Register of Controlled Trials databases. Studies were included if they were randomised controlled trials (RCTs) involving interventions with oral metronidazole at any dose over any time period. The primary outcome was pain score (visual analogue scale, VAS) after open haemorrhoidectomy. Secondary outcomes included time to return to normal daily activities, additional analgesia usage, and postoperative complications.

RESULTS: Of 14 RCTs reviewed, 4 met inclusion criteria and were selected. The studies comprised 336 study subjects and 169 subjects were randomised to metronidazole while 167 were in the control group. There was a significant reduction in VAS across all time points, with maximal reduction seen on day 5 posthaemorrhoidectomy (mean difference, -2.28; 95% confidence interval, -2.49 to -2.08; P < 0.001). There was no difference in incidence of complications (P = 0.13). The Cochrane Risk of Bias Tool showed 3 of 4 of the studies had a risk of bias.

CONCLUSION: Metronidazole may be associated with decreased pain but there is insufficient evidence from RCTs to provide a strong grade of recommendation. Further RCTs are required.

Keywords: Haemorrhoidectomy; Metronidazole; Open haemorrhoidectomy; Postoperative pain

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