Efeito sinérgico do uso do flavonoide e do metronidazol no controle da dor nas hemorroidectomias à Milligan-Morgan: ensaio clínico duplo cego randomizado

Abstract

The excisional hemorrhoidectomy is still the most effective treatment for a significant portion of patients with hemorrhoids grade III and IV, while promoting a post-operative period considered painful, which can be minimized by drug and surgical strategies currently available. Objective: To evaluate the effect of the use of flavonoid and metronidazole in postoperative patients undergoing hemorrhoidectomy. Method: Through a randomized double-blind clinical trial, 68 patients with hemorrhoids grade III and IV, submitted to hemorrhoidectomy, were studied, assessing pain, bleeding, swelling, itching and postoperative tenesmus. Patients were allocated, by a simple draw without replacement in four groups: double placebo (GP) placebo plus metronidazole (GPM), placebo + flavonoid (GPF) and metronidazole + flavonoid (GMF). All patients were operated on using the technique of Milligan-Morgan, under sedation and local anesthesia and postoperative symptoms were evaluated in three periods, namely the immediate postoperative period to 7ºDPO, the 8th to 14ºDPO, the 15th the 30ºDPO. The effect of each drug was examined for each symptom, comparing the groups with each other and over time. Results: Pain intensity was lower in all postoperative time in the groups using the flavonoid (p <0.0001) and was observed synergistic effect of the combination with metronidazole in the first 14 days after surgery (GMF; p <0.0001). The use of the flavonoid also decreased bleeding and edema between the first and the second postoperative week. As for the tenesmus, there was synergistic effect of the combined use of drugs in 14ºDPO. In the temporal evolution, between the 7th and the 14ºDPO, tenesmus was lower in the groups using metronidazole, both separately (GPM) and in association with flavonoid (GMF). Itching, in turn, was more prevalent in the group using metronidazole alone (GPM) between the second and fourth weeks postoperatively. Conclusions: The use of metronidazole and especially of flavonoid and the association of both medications, was able to enhance most signs and symptoms after hemorrhoidectomy, especially the pain. Thus this approach should be considered after this type of surgery.