Abstract
Abstract: Postoperative anal pain is one of the main adverse effects of surgical treatment of benign anorectal diseases and remains a distressing problem, for both patients and physicians. Postoperative pain control is important yet it remains an unresolved issue which causes patient dissatisfaction and negatively impact quality of life. This review article studied the analgesic effect of topical and oral metronidazole after benign anorectal surgery. Seven studies used oral metronidazole and six used topical metronidazole. The studies showed that post operative pain score of patients who had metronidazole by either route was significantly less than those in comparison groups. The pain score decreased at all the time points for both oral and topical metronidazole. Overall, the analgesic effect of oral metronidazole was inconsistent among published studies. When topical and oral metronidazole were compared the post operative pain score and analgesic consumption were lower in topical metronidazole than the oral group.
Highlights
Anal surgeries are among the most commonly performed operations all over the world
The use of several medications during or after anal surgery for the reduction of postoperative pain has been extensively discussed in the literature
Gupta et al found that topical sucralfate significantly reduced pain after hemorrhoidectomy up to two weeks postoperatively and provided quicker wound healing in comparision to that of a placebo group [15]
Summary
The most common fear of patients undergoing such surgeries is the postoperative pain which can be quite annoying and may delay return to daily activities [1]. Post-anal surgery pain is multifactorial; internal anal sphincter spasm, inflammation and superadded bacterial contamination of the operative site have a role [2,3,4]. Many pharmacologic agents (with different mechanisms of action) have been tried to decrease the post-operative pain as anesthetics, internal sphincter relaxants, opioid and non-opioid analgesics, flavonoids, sucralfate & antibiotics [9]. Topical preparations are preferred over other dosage forms because of better bioavailability and fewer incidence of side effects [10]. Metronidazole is a nitroimidazole member that acts against anaerobic pathogens & protozoa and is used extensively because it is safe, cheap, efficacious, with relatively little side effects [11]
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