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Systematic review and meta‐analysis of the role of metronidazole in post‐haemorrhoidectomy pain relief
Author(s) -
Lyons N. J. R.,
Cornille J. B.,
Pathak S.,
Charters P.,
Daniels I. R.,
Smart N. J.
Publication year - 2017
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13755
Subject(s) - medicine , metronidazole , meta analysis , randomized controlled trial , visual analogue scale , surgery , systematic review , anesthesia , medline , antibiotics , political science , law , microbiology and biotechnology , biology
Aim Conventional haemorrhoidectomy is still considered the reference standard for the management of severe or recurrent haemorrhoids. Pain is reported by patients to be the most common postoperative complication. Although the literature lacks a consensus on its effectiveness, metronidazole is often used to reduce postoperative pain. We have performed a meta‐analysis of all randomized controlled trials ( RCT s) that investigated the use of metronidazole for pain relief after haemorrhoidectomy. Method A systematic review was undertaken in accordance with the PRISMA protocol using the MESH headings ‘haemorrhoidectomy’, ‘hemorhoidectomy’, ‘hemorrhoidectomy’, ‘haemorrhoid’, ‘metronidazole’, ‘Flagyl ® ’ ‘antibiotic’ and ‘pain’. The search returned 421 articles of which eight were RCT s suitable for inclusion in the review with a total population of 437 patients. The outcomes of interest were postoperative pain intensity on days 1, 2 and 7 and on first defaecation as measured using a visual analogue scale. Results The meta‐analysis demonstrated a significant reduction in postoperative pain for patients treated with metronidazole with a reduced mean difference for the metronidazole group on day 1 of −1.42 (95% CI : −2.14 to −0.69, P = 0.0001), on day 2 of −1.43 (95% CI: −2.45 to −0.40, P = 0.006) and on day 7 of −2.40 (95% CI : −3.10 to −1.71, P < 0.00001). Pain on first defaecation was likewise reduced with a mean difference of −1.38 (95% CI : −2.15 to −0.60, P = 0.0005). Limitations of this study include variation in the grade of haemorrhoids treated and variability in the quality of included studies. Conclusion Metronidazole is a cheap, safe and effective intervention for reducing postoperative pain following conventional haemorrhoidectomy.