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Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Vincent de PARADES
Coup de coeur :
 
 
International Journal of Colorectal Disease
  2018/07  
 
  2018 Jul;33(7):895-899.  
  doi: 10.1007/s00384-018-3067-x  
 
  A prospective randomized double-blind study of pain control by topical calcium channel blockers versus placebo after Milligan-Morgan hemorrhoidectomy.  
 
  Yadav S, Khandelwal RG, Om P, Ravindra K, Choudhary KL  
  https://www.ncbi.nlm.nih.gov/pubmed/29721732  
 
 

Abstract

INTRODUCTION:

Post-hemorrhoidectomy pain is significantly associated with a hypertonicity of the internal anal sphincter. We evaluated the effects of topical diltiazem, a calcium channel blocker, in reducing pain after hemorrhoidectomy. Purpose of our study was to determine difference in extent of pain control by application of topical calcium channel blocker (diltiazem 2%) versus placebo ointment.

METHODS:

This was a prospective randomized double-blind clinical study conducted at Sawai Man Singh Hospital, Jaipur, from May 2016 to May 2017. Sixty patients, who had undergone hemorrhoid, were randomly assigned to receive 2% diltiazem ointment (n = 30) or a placebo ointment (n = 30) postoperatively. Ointments were applied to the perianal region three times daily for 7 days. Pain scores were recorded using visual analog scale at 6, 24, and 48 h and seventh day postoperatively and number of analgesic doses consumed by patients in the first 3 days.

RESULTS:

Patients using the diltiazem ointment had significantly less pain and greater benefit than those in the placebo group throughout the first postoperative week (p < 0.001) except for reading at 6 h. Also, there was significantly less number of analgesic doses consumed in the diltiazem group compared to the placebo group.

CONCLUSION:

Perianal application of 2% diltiazem ointment after hemorrhoidectomy significantly reduces postoperative pain and is perceived as beneficial.

 

 
Question posée
 
Quel est l’effet sur la douleur postopératoire du diltiazem en applications locales après hémorroïdectomie tripédiculaire ?
 
Question posée
 
Ce petit essai contrôlé randomisé en double aveugle a montré une efficacité supérieure du diltiazem au placebo pour soulager la douleur de la première semaine postopératoire et ce sans effet indésirable notable.
 
Commentaires

Toute tentative de plus grand soulagement de la douleur après hémorroïdectomie tripédiculaire est bienvenue, à fortiori en un temps où la prise en charge ambulatoire est de plus en plus « pressante ». De surcroît, un inhibiteur calcique en applications locales sera bientôt commercialisé en France.

 
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