Nitroderm TTS band application for pain after hemorrhoidectomy

Anal sphincter spasm is believed to play an important role in pain after hemorrhoidectomy. We tested a different form of nitroglycerin: the Nitroderm TTS band. We investigated its efficacy on posthemorrhoidectomy pain and the relation between pain and anal resting pressure measured preoperatively and postoperatively.

Thirty-eight hemorrhoid patients were divided into two groups: those with high anal resting pressure were classified as group A (n = 24) and those with low anal resting pressure were classified as group B (n = 14). After hemorrhoidectomy, Nitroderm TTS bands were placed into the anal canal in half of the patients in groups A and B (groups A-1 and B-1) and not in the remaining half (groups A-2 and B-2). Anal resting pressure measurement was repeated at the first day and third month postoperatively. Postoperative pain was assessed by linear analog scale, and analgesic consumption was recorded.

Preoperative anal resting pressure was 112.0 (range, 95-140) cm H2O in group A-1 and 110.6 (range, 96-138) cm H2O in group A-2. The difference was insignificant. However, on the first postoperative day, anal resting pressures were 88.7 (range, 75-115) and 110.9 (range, 92-135) cm H2O (P = 0.0001), and at the third month, they were 76.5 (range, 70-100) and 78.0 (range, 70-105) cm H2O, respectively (P = 0.690). Postoperative pain scores were significantly lower in group A-1 than group A-2 (P = 0.0001). In the low-pressure groups (B-1 and B-2), anal resting pressures before surgery, on the first postoperative day, and at the third month postoperatively were 70.4 (range, 56-76), 67.4 (range, 50-75), and 67.2 (range, 55-74) cm H2O in group B-1 and 69.8 (range, 58-76), 70.2 (range, 60-76), and 68.4 (range, 60-74) cm H2O in group B-2. The differences were insignificant (P > or = 0.660). The differences between pain scores in these groups were also insignificant (P > or = 0.160).

Nitroderm TTS bands effectively reduced anal resting pressure and relieved pain in patients with high preoperative anal resting pressure.