Botulinum toxin (Botox®) reduces pain after hemorrhoidectomy -: Results of a double-blind, randomized study

被引:60
作者
Davies, J [1 ]
Duffy, D [1 ]
Boyt, N [1 ]
Aghahoseini, A [1 ]
Alexander, D [1 ]
Leveson, S [1 ]
机构
[1] York Dist Gen Hosp, Dept Colorectal Surg, York YO31 8HE, N Yorkshire, England
关键词
hemorrhoidectomy; botulinum toxin; randomized; controlled trial;
D O I
10.1007/s10350-004-7286-6
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Purpose: Pain after hemorrhoidectomy appears to be multifactorial and dependent on individual pain tolerance, mode of anesthesia, postoperative analgesia, and surgical technique. Spasm of the internal sphincter is believed to play an important role. The aim of this study was to assess the role of botulinum toxin in reducing pain after Milligan-Morgan hemorrhoidectomy. Methods: This was a double-blind study of 50 consecutive patients undergoing Milligan-Morgan hemorrhoidectomy and assigned to an internal sphincter injection of 0.4 ml of solution containing either botulinum toxin (20 U;, Botox(R)) or normal saline. Patients were managed according to standardized perioperative analgesic and laxative regimens. Pain was assessed by use of daily visual analog scores and analgesia requirements for the first seven postoperative days. Results: Patients randomized to receive botulinum toxin had lower daily average and maximal visual analog scores throughout the study period. The difference reached significance on both Day 6 (P<0.05) and Day 7 (P<0.05). There was no significant difference (P=0.12) in morphine requirements in the first 24 hours (botulinum group, 16 (range, 6-27) mg; placebo arm, 22 (range, 13-41) mg). Patients who received Botox(R) used 19 (range, 8-36) coproxamol tablets in the first seven days after surgery compared with 23 (range, 10-40) in the placebo arm (P=0.63). Conclusions: Those patients who had botulinum toxin had significantly less pain toward the end of the first week after surgery. Reduction in spasm within the internal sphincter is the presumed mechanism of action. This is the first reported randomized, controlled trial using botulinum toxin in hemorrhoidectomy.
引用
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页码:1097 / 1102
页数:6
相关论文
共 28 条
[1]   RANDOMIZED TRIAL COMPARING DIATHERMY HEMORRHOIDECTOMY WITH THE SCISSOR DISSECTION MILLIGAN-MORGAN OPERATION [J].
ANDREWS, BT ;
LAYER, GT ;
JACKSON, BT ;
NICHOLLS, RJ ;
CHIR, M .
DISEASES OF THE COLON & RECTUM, 1993, 36 (06) :580-583
[2]   A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure [J].
Brisinda, G ;
Maria, G ;
Bentivoglio, AR ;
Cassetta, E ;
Gui, D ;
Albanese, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (02) :65-69
[3]   Randomized trial of open versus closed day-case haemorrhoidectomy [J].
Carapeti, EA ;
Kamm, MA ;
McDonald, PJ ;
Chadwick, SJD ;
Phillips, RKS .
BRITISH JOURNAL OF SURGERY, 1999, 86 (05) :612-613
[4]  
Cheetham M J, 2001, Colorectal Dis, V3, P126, DOI 10.1046/j.1463-1318.2001.00189.x
[5]   Persistent pain and faecal urgency after stapled haemorrhoidectomy [J].
Cheetham, MJ ;
Mortensen, NJM ;
Nystrom, PO ;
Kamm, MA ;
Phillips, RKS .
LANCET, 2000, 356 (9231) :730-733
[6]   Nitroderm TTS® band application for pain after hemorrhoidectomy [J].
Coskun, A ;
Duzgun, SA ;
Uzunkoy, A ;
Bozer, M ;
Aslan, O ;
Canbeyli, B .
DISEASES OF THE COLON & RECTUM, 2001, 44 (05) :680-685
[7]  
Galizia G, 2000, EUR J SURG, V166, P223
[8]   Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy [J].
Ganio, E ;
Altomare, DF ;
Gabrielli, F ;
Milito, G ;
Canuti, S .
BRITISH JOURNAL OF SURGERY, 2001, 88 (05) :669-674
[9]   VALUE OF STRETCHING ANAL SPHINCTERS IN RELIEF OF POST-HAEMORRHOIDECTOMY PAIN [J].
GOLIGHER, JC ;
GRAHAM, NG ;
CLARK, CG ;
DEDOMBAL, FT ;
GILES, G .
BRITISH JOURNAL OF SURGERY, 1969, 56 (11) :859-&
[10]  
GOLIGHER JC, 1984, SURG ANUS RECTUM COL