Is metronidazole a panacea for post-hemorrhoidectomy pain?

Abstract

Background: Pain following Milligan Morgan hemorrhoidectomy is a significant cause of morbidity. The present study was carried out to find out if using metronidazole in the post-operative period of these patients results in less post-operative pain.Methods: This was a prospective randomized controlled trial which was conducted on 67 consecutive patients attending the Surgical OPD at SRN Hospital, Allahabad during the study period between August 2016 and July 2017 who underwent surgery for grade 2, grade 3 and grade 4 hemorrhoids. The patients were allocated to 3 groups-one group was the control group, the second group received oral metronidazole post-operatively for 7 days while the third group received only topical metronidazole for 7 days. All the three groups received 500 mg of metronidazole in 100 ml infusion pre-operatively. The post-operative analgesic usage was standardized for all the three groups. Appropriate tests of significance were applied to assess if the difference in the intensity of post-operative pain was significant in the immediate post-operative period and on days 1, 3 and 7 post-surgery.Results: Pain relief was significantly better in the groups using metronidazole at post-operative day 1, 3 and 7 and this was also borne in the lesser number of analgesics used by the patients of these groups.Conclusions: Use of oral or topical metronidazole in the post-operative period results in clinically significant pain relief. There is no additional benefit of one over the other and hence either can be used.