Table 11: Anti-infectives versus placebo/no treatment
Study | Surgery type | n treatment/ control | Comparison | Supplemental analgesia | Pain scores and type if specified | Use of supplemental analgesia | Other pain outcomes | Functional outcomes | Other important outcomes |
(Balfour 2002) LoE 1 | Closed haemorrhoidectomy with diathermy dissection | 16/19 | Oral metronidazole 400 mg (M) vs. placebo (P), three times daily for seven days after surgery | Cocodamol (codeine 30 mg plus paracetamol 500 mg) and diclofenac 50 mg as necessary | NS pain expected and pain experienced throughout 2 postop weeks (POD 1–7 and 14) | NS number of patients requiring rescue analgesia | Not reported | Time to first bowel movement: NS | Number of days to return to normal activity: NS Overall satisfaction at 1 and 6 weeks: NS |
(Carapeti 1998) LoE 1 | Standard diathermy haemorrhoidectomy | 20/20 | Oral metronidazole 400 mg 3 x daily for 7 days (M) vs. placebo (P) at the same time points | Diclofenac 50 mg orally 3 x per day for 1 week, paracetamol or dihydrocodeine + paracetamol for additional analgesia | Pain scores experienced: M superior on day 5 (p=0.004), 6 (p=0.02) and 7 (p=0.006), NS on days 1–4 | NS number of patients requiring paracetamol or codydramol for rescue analgesia | Summary scores experience of pain and pain expectation: M superior (p=0.004) | NS time to first bowel movement | Time to return to work/normal activities: M superior (p=0.009) Patient satisfaction scores: M superior at 1 week (p=0.005), NS at 6 weeks Incidence of complications: NS |
LoE 1 | Conventional diathermy dissection haemorrhoidectomy | 100/100 | IV metronidazole 500 mg at anaesthetic induction, at 2 h, and at 10 h postop, followed by 500 mg orally 3 x per day for 3 days (M), vs. no treatment (NT) | Diclofenac 50 mg orally 3 x per day. Pethidine injections 1mg/kg | Pain scores experienced: M superior on 0 (p?0.05), 1, 2, 3, 4, 5, 6 and 7 days (all p?0.001). Pain scores expected: M superior for 0–7 days (all p?0.001) | No stats on number of additional pethidine injections required – more patients in NT required them | Number of patients experiencing moderate pain (score 4-7): M superior (p=0.0233). Severe pain: M superior (no ‘p’ value reported). Expected pain: as expected M superior (p=0.0043), far worse M superior (no ‘p’ value reported). | Time to first bowel movement: NS Complete wound healing at 6 weeks: M superior (no stats) Constipation: M superior (no stats) | Time to return to normal activities: M superior (p?0.05) Length of hospital stay: NS Urinary retention: M superior (no stats) |
(Nicholson 2004) LoE 1 | Closed three-quadrant Harmonic Scalpel® haemorrhoidectomy | 10/10 | Topical metronidazole 10% cream (M) vs. placebo cream (P); approximately 2.5 cc of cream applied to the surgical site three times daily for 28 days after a sitz bath or warm soak | Hydrocodone orally 10 mg every 4–6 h | VAS pain scores: M superior on day 7 (p=0.002) and 14 (p=0.02), NS on day 1, 2 and 28 | NS narcotic requirement on days 1, 2, 7, 14 and 28 | Not reported | Wound healing: postoperative oedema M superior (p<0.01), overall healing M superior (p=0.03) Primary versus secondary healing: NS | Not reported |