A prospective randomized double-blind study of pain control by topical calcium channel blockers versus placebo after Milligan-Morgan hemorrhoidectomy

Int J Colorectal Dis. 2018 Jul;33(7):895-899. doi: 10.1007/s00384-018-3067-x. Epub 2018 May 2.


Introduction: Post-hemorrhoidectomy pain is significantly associated with a hypertonicity of the internal anal sphincter. We evaluated the effects of topical diltiazem, a calcium channel blocker, in reducing pain after hemorrhoidectomy. Purpose of our study was to determine difference in extent of pain control by application of topical calcium channel blocker (diltiazem 2%) versus placebo ointment.

Methods: This was a prospective randomized double-blind clinical study conducted at Sawai Man Singh Hospital, Jaipur, from May 2016 to May 2017. Sixty patients, who had undergone hemorrhoid, were randomly assigned to receive 2% diltiazem ointment (n = 30) or a placebo ointment (n = 30) postoperatively. Ointments were applied to the perianal region three times daily for 7 days. Pain scores were recorded using visual analog scale at 6, 24, and 48 h and seventh day postoperatively and number of analgesic doses consumed by patients in the first 3 days.

Results: Patients using the diltiazem ointment had significantly less pain and greater benefit than those in the placebo group throughout the first postoperative week (p < 0.001) except for reading at 6 h. Also, there was significantly less number of analgesic doses consumed in the diltiazem group compared to the placebo group.

Conclusion: Perianal application of 2% diltiazem ointment after hemorrhoidectomy significantly reduces postoperative pain and is perceived as beneficial.

Keywords: Analgesic; Diltiazem; Posthemorrhoidectomy pain; Topical.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Administration, Topical
  • Adolescent
  • Adult
  • Calcium Channel Blockers / therapeutic use*
  • Double-Blind Method
  • Female
  • Hemorrhoidectomy*
  • Hemorrhoids / surgery*
  • Humans
  • India
  • Male
  • Middle Aged
  • Pain, Postoperative
  • Prospective Studies
  • Treatment Outcome


  • Calcium Channel Blockers