Randomised clinical trial of effect of oral nifedipine on pain and healing after hemorrhoidectomy

Hemorrhoidectomy has the best long-term results and is the only effective treatment for symptomatic third and fourth degree hemorrhoids. Patients and doctors consider it a painful operation. Nifedipine reduces the activity of the internal anal sphincter and relieves symptoms in patients with haemorrhoids or anal fissure. The aim of this study was to evaluate the effect of oral nifedipine after haemorrhoidectomy.We randomly assigned 40 consecutive patients admitted for hemorrhoidectomy by Milligan Morgan technique. Group 1 (n=20) is the control group, group 2 (n=20) is the study group. All received habitual treatment; lactulose as stool softener, metronidazole 500 mg three times daily for seven postoperative days, and ketorolac tromethamine as analgesic. Group 2 additionally received oral nifedipine 20 mg twice daily from 2 days before surgery until wound healing. Linear analog scales were used to assess pain. Time to first bowel movement, return to normal activity, complications, and use of additional analgesics were recorded. Patients were reviewed and assessed postoperatively every week for measurement of blood pressure, pulse rate, wound healing and adverse effects until return to work. Patients in the oral nifedipine group had significantly less pain, less analgesics consumption [median 18 (12 - 38) vs 33 (25 - 48)] (P=0,021). Median time to healing the wounds was 28 days (range 14 - 40) in the oral nifedipine group and 40 days (21 - 60) in the control group (P=0,023). Median time to return to work or normal activity was 37.5 days (range 20 - 80) in the oral nifedipine group and 47.5 days (20 - 115) in the control group (P=0,445). There was no significant change in baseline pulse rate or systolic and diastolic blood pressure. Headache occurred in 4 patients who responded to paracetamol. The use of oral nifedipine reduced postoperative pain, analgesic consumption, and promoted earlier wounds healing and return to work. And we suggest its inclusion in routine posthemorrhoidectomy treatment.