Headache With Local Application Of Glyceryl Trinitrate And Diltiazem In Chronic Anal Fissure: A Randomized Controlled Trial

Objectives: To compare the frequency and severity of headache after topical application of 0.2%-glyceryl trinitrate (GTN) versus 2%-diltiazem ointment in the treatment of chronic anal fissures. Methodology: This clinical trial was carried out in the outpatient department of all surgical units of the Civil Hospital Karachi from 21st August 2009 to 20th February 2010. Eighty patients of chronic anal fissure were randomly assigned to receive topical 0.2%-GTN (group A) and 2%-diltiazem ointments (group B). Forty patients were included in each group. Frequency and severity of headache were then determined with one week of follow-up. The SPSS version 11 was used for the data analysis. Results: There were 65 (81.3%) males and 15 (18.7%) females with a mean (+SD) age of 38.79 (+14.86) years. There was a statistically significant difference in headache (30% in the GTN versus 7.5% in the diltiazem group; p=0.02). In two (5%) patients of the GTN group, the treatment had to be abandoned due to severe headache. However, none of the participants of the diltiazem group experienced severe pain. Conclusion: Headache is common with the use of topical GTN ointment as compared to topical diltiazem. It is sometimes severe enough to compel the patient to discontinue treatment.