Post hemorrhoidectomy pain. A randomized controlled trial

OBJECTIVE: To compare the effect of metronidazole on post conventional hemorrhoidectomy pain in patients with third and fourth degree hemorrhoids. METHODS: Two hundred consecutive patients admitted in King Fahad Hospital, Hofuf, Saudi Arabia between June 2002 and May 2004 for surgical treatment of 3rd and 4th degree hemorrhoids were randomly assigned into 2 groups. In Group 1 (100 patients) pre and postoperative metronidazole was used and in Group 2 (100 patients) no medications were given. All patients received castor oil from 2 days before surgery and lactulose after surgery for 2 weeks. Patients were discharged home when free of pain. RESULTS: Patients in group 1 had significantly less pain than those in the second group. Hospital stay and time to first bowel motion were not significantly different between both groups and, early and late complications appear similar. Return to normal activity was significantly shorter in the metronidazole group. CONCLUSION: Prophylactic metronidazole in Milligan-Morgan hemorrhoidectomy is associated with less pain and earlier return to normal activity.