Table 10: Flavonoids versus no treatment

Study

Surgery type

n treatment/ control

Comparison

Supplemental analgesia

Pain scores and type if specified

Use of supplemental analgesia

Functional outcomes

Other important outcomes

(Colak 2003); LoE 1)

Standard three-column haemorrhoid excision

56/56

MFF 1500 mg orally twice per day for 3 days then 1000 mg twice per day for 4 days (MFF) versus no treatment (C)

Diclofenac IM if pain score ?5, dipyrone orally if pain score ?4

Pain scores: MFF superior on day 2 (p=0.033), 3 (p=0.011) and 7 (p=0.001), NS on day 1

Number of patients requiring IM diclofenac injections: MMF superior on day 2 (p=0.022), 3 (p=0.007), and overall (p=0.021), NS on day 1. Duration of analgesic requirement: MMF superior (p=0.046)

Not reported

Incidence of urinary retention:

NS

Length of hospital stay:

MMF superior (p=0.001)

Patient satisfaction scores:

MMF superior (p=0.001)

(LaTorre 2004); LoE 1)

Open haemorrhoidectomy (Milligan-Morgan technique)

25/25

30-day treatment with MPFF: two 500 mg tablets every 12 h (4 tablets per day, i.e. 2000 mg/day) from POD1 for up to 10 days, then one tablet twice daily (two tablets per day, i.e. 1000 mg/day) for the remaining 20 days (MPFF), versus no treatment (C)

Ketorolac 30 mg administered IM on day 1, then orally (two tablets in the morning) over the next 5 days

Pain scores over the first 3 days: MPFF superior (p<0.0001). Pain score after 60 days: MPFF superior (p<0.0001)

Not reported

Tenesmus scores (over the first 3 days):

MPFF superior (p<0.0001)

Tenesmus score (after 60 days):

MPFF superior (p<0.0001)

Bleeding scores (over the first 3 days):

MPFF superior (p<0.0001). Bleeding score (after 60 days):

MPFF superior (p<0.0001). Pruritus scores (over the first 3 days):

MPFF superior (p<0.0001). Pruritus score (after 60 days):

MPFF superior (p<0.0001)

(Mlakar 2005)

LoE 2

Stapled anopexy

30/33

MPFF (Detralex®) 500 mg, two tablets orally three times per day for 5 days (MPFF) versus no treatment (C)

Naproxen and tramadol for analgesia

NS VAS pain scores

NS consumption of tramadol or naproxen

Not reported

Duration of bleeding:

NS

MFF = micronized flavonoid fraction, MPFF = micronized purified flavonoid fraction

Study	Surgery type	n treatment/ control	Comparison	Supplemental analgesia	Pain scores and type if specified	Use of supplemental analgesia	Functional outcomes	Other important outcomes
(Colak 2003); LoE 1)	Standard three-column haemorrhoid excision	56/56	MFF 1500 mg orally twice per day for 3 days then 1000 mg twice per day for 4 days (MFF) versus no treatment (C)	Diclofenac IM if pain score ?5, dipyrone orally if pain score ?4	Pain scores: MFF superior on day 2 (p=0.033), 3 (p=0.011) and 7 (p=0.001), NS on day 1	Number of patients requiring IM diclofenac injections: MMF superior on day 2 (p=0.022), 3 (p=0.007), and overall (p=0.021), NS on day 1. Duration of analgesic requirement: MMF superior (p=0.046)	Not reported	Incidence of urinary retention: NS Length of hospital stay: MMF superior (p=0.001) Patient satisfaction scores: MMF superior (p=0.001)
(LaTorre 2004); LoE 1)	Open haemorrhoidectomy (Milligan-Morgan technique)	25/25	30-day treatment with MPFF: two 500 mg tablets every 12 h (4 tablets per day, i.e. 2000 mg/day) from POD1 for up to 10 days, then one tablet twice daily (two tablets per day, i.e. 1000 mg/day) for the remaining 20 days (MPFF), versus no treatment (C)	Ketorolac 30 mg administered IM on day 1, then orally (two tablets in the morning) over the next 5 days	Pain scores over the first 3 days: MPFF superior (p<0.0001). Pain score after 60 days: MPFF superior (p<0.0001)	Not reported	Tenesmus scores (over the first 3 days): MPFF superior (p<0.0001) Tenesmus score (after 60 days): MPFF superior (p<0.0001)	Bleeding scores (over the first 3 days): MPFF superior (p<0.0001). Bleeding score (after 60 days): MPFF superior (p<0.0001). Pruritus scores (over the first 3 days): MPFF superior (p<0.0001). Pruritus score (after 60 days): MPFF superior (p<0.0001)
(Mlakar 2005) LoE 2	Stapled anopexy	30/33	MPFF (Detralex®) 500 mg, two tablets orally three times per day for 5 days (MPFF) versus no treatment (C)	Naproxen and tramadol for analgesia	NS VAS pain scores	NS consumption of tramadol or naproxen	Not reported	Duration of bleeding: NS