The efficacy of diltiazem, glyceryl trinitrate, nifedipine, minoxidil, and lidocaine for the medical management of anal fissure: a systematic review and network meta-analysis of randomized controlled trials.
Cong Wang, Jing Ni, Yi Xiong, Jinlan Chen, Binting Li, Li Xu
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引用次数: 0
Abstract
Purpose: Anal fissure (AF) is a common anorectal condition causing pain, bleeding, and other perianal discomfort. This study conducts a network meta-analysis to compare the efficacy and side effect profiles of pharmacological treatments for AF, including diltiazem, glyceryl trinitrate, nifedipine, minoxidil, and Lidocaine.
Methods: Following PRISMA guidelines, a systematic review and network meta-analysis were performed. Randomized controlled trials (RCTs) comparing non-surgical treatments for AF were sourced from PubMed, Cochrane Library, Embase, and Medline. The primary outcome was AF healing, with secondary outcomes including recurrence rates, pain reduction (visual analog scale), and adverse effects. Statistical analysis utilized odds ratios and SUCRA (Surface Under the Cumulative Ranking) values for treatment ranking.
Results: Twenty-two randomized controlled trials (RCTs) involving a total of 1,770 participants were included in the analysis. Nifedipine demonstrated the highest healing rate, followed by diltiazem and minoxidil. Lidocaine exhibited the lowest healing rate. Diltiazem had the lowest recurrence rate and was the most effective in pain reduction, whereas lidocaine had the highest recurrence rate and was the least effective in alleviating pain. The incidence of adverse effects with minoxidil was relatively low, second only to lidocaine, while glyceryl trinitrate had the highest rate of adverse effects.
Conclusion: Nifedipine had the highest healing rate and should be considered as a first-line non-surgical treatment for anal fissures. Given the elevated incidence of adverse reactions associated with nitroglycerin, its use should be avoided in order to minimize the risk of significant toxicities and side effects. Additionally, because of its outstanding analgesic properties, diltiazem is recommended as the preferred option for patients with heightened sensitivity to pain, but more studies are needed to evaluate its efficacy.
期刊介绍：
The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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