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Efficacy of cholestyramine ointment in reduction of postoperative pain and pain during defecation after open hemorrhoidectomy: results of a prospective, single-center, randomized, double-blind, placebo-controlled trial.

AbstractBACKGROUND:
The aim of the present study was to evaluate the efficacy of cholestyramine ointment (15 %) in reducing postoperative pain at rest and during defecation after open hemorrhoidectomy.
METHODS:
A total of 91 patients with third and fourth degree hemorrhoids undergoing open hemorrhoidectomy were included in this prospective, double-blind, randomized controlled trial. The patients were randomly assigned to either cholestyramine ointment or placebo immediately after surgery, 12 h after surgery, and then every 8 h for 14 days. The primary outcomes were intensity of pain at rest and during defecation, measured with a visual analog scale, and the analgesic requirement, measured by amount of tramadol consumption.
RESULTS:
The cholestyramine group had less postoperative pain than the placebo group at the 24th hour (1.84 ± 2.54 vs. 4.07 ± 3.35; P = 0.001) and 48th hour (0.18 ± 0.88 vs. 3.57 ± 3.45; P < 0.001) and less pain during defecation starting at the 48th hour (2.28 ± 2.96 vs. 4.77 ± 4.09; P = 0.001). Similarly, the average tramadol consumption at hours 24 and 48 was significantly lower for the cholestyramine group (5.32 ± 21.45 vs. 43.18 ± 61.56 mg at 24 h, and 4.48 ± 16.65 vs. 57.63 ± 65.47 mg at 48 h; P < 0.001). The only adverse event was pruritus, which had a lower frequency in the cholestyramine group but the difference was not significant until postoperative week 4 (P < 0.001).
CONCLUSIONS:
Compared with placebo, cholestyramine ointment (15%) reduced postoperative pain at rest and on defecation, and consequently lowered the analgesic requirement after open hemorrhoidectomy.
AuthorsShahram Ala, Fariborz Eshghi, Reza Enayatifard, Payam Fazel, Banafsheh Rezaei, Roja Hadianamrei
JournalWorld journal of surgery (World J Surg) Vol. 37 Issue 3 Pg. 657-62 (Mar 2013) ISSN: 1432-2323 [Electronic] United States
PMID23229850 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Anion Exchange Resins
  • Ointments
  • Cholestyramine Resin
Topics
  • Administration, Topical
  • Adult
  • Anion Exchange Resins (administration & dosage)
  • Cholestyramine Resin (administration & dosage)
  • Defecation
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Hemorrhoidectomy (methods)
  • Hemorrhoids (diagnosis, surgery)
  • Humans
  • Male
  • Middle Aged
  • Ointments (therapeutic use)
  • Pain Measurement (drug effects)
  • Pain, Postoperative (drug therapy, prevention & control)
  • Prospective Studies
  • Reference Values
  • Severity of Illness Index
  • Treatment Outcome

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