{"title":"Comparative efficacy of lidocaine- and nifedipine-based conservative therapies in acute hemorrhoidal disease: A retrospective cohort study.","authors":"Michele Schiano di Visconte","doi":"10.1016/j.surge.2025.06.002","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Acute hemorrhoidal disease (AHD) is a prevalent anorectal condition that significantly impacts patients' quality of life and healthcare systems. Despite the availability of various conservative treatments, comparative efficacy data remains limited. This retrospective study evaluates two treatment regimens for AHD, focusing on symptom relief, patient-reported outcomes, and treatment tolerability.</p><p><strong>Methods: </strong>Medical records of 123 patients with AHD treated at a tertiary care center between October 2022 and October 2024 were reviewed. Patients were divided into two groups: Group A treated with oral diosmin/hesperidin, bromelain, and topical lidocaine, and Group B treated with oral diosmin/hesperidin, bromelain, and topical nifedipine. Symptoms were evaluated using the Hemorrhoidal Disease Symptom Score (HDSS), Visual Analog Scale (VAS) for pain, and Short Health Scale for Hemorrhoidal Disease (SHS-HD) at baseline and on days 7, 14, and 21.</p><p><strong>Results: </strong>Both groups showed significant improvements in symptoms during the study period. Group A demonstrated faster pain reduction (VAS day 7:0.17 ± 0.52 vs. 2.20 ± 1.11, p < 0.001) and greater improvement in HDSS score (day 7: 0.02 ± 0.87 vs. 10.16 ± 3.38, p < 0.001). Improvements in SHS-HD scores were more rapid for Group A, with scores on day 7 showing a significant difference (Group A: 7.58 ± 2.58 vs. Group B: 12.27 ± 4.21, p < 0.001). Both regimens were well tolerated, with no significant adverse events.</p><p><strong>Conclusions: </strong>The combination of oral diosmin/hesperidin, bromelain, and lidocaine provides superior initial symptom relief compared with nifedipine-based regimens. Lidocaine is the preferred topical agent for rapid pain management in AHD patients. Further studies are required to confirm these results.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.surge.2025.06.002","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Acute hemorrhoidal disease (AHD) is a prevalent anorectal condition that significantly impacts patients' quality of life and healthcare systems. Despite the availability of various conservative treatments, comparative efficacy data remains limited. This retrospective study evaluates two treatment regimens for AHD, focusing on symptom relief, patient-reported outcomes, and treatment tolerability.
Methods: Medical records of 123 patients with AHD treated at a tertiary care center between October 2022 and October 2024 were reviewed. Patients were divided into two groups: Group A treated with oral diosmin/hesperidin, bromelain, and topical lidocaine, and Group B treated with oral diosmin/hesperidin, bromelain, and topical nifedipine. Symptoms were evaluated using the Hemorrhoidal Disease Symptom Score (HDSS), Visual Analog Scale (VAS) for pain, and Short Health Scale for Hemorrhoidal Disease (SHS-HD) at baseline and on days 7, 14, and 21.
Results: Both groups showed significant improvements in symptoms during the study period. Group A demonstrated faster pain reduction (VAS day 7:0.17 ± 0.52 vs. 2.20 ± 1.11, p < 0.001) and greater improvement in HDSS score (day 7: 0.02 ± 0.87 vs. 10.16 ± 3.38, p < 0.001). Improvements in SHS-HD scores were more rapid for Group A, with scores on day 7 showing a significant difference (Group A: 7.58 ± 2.58 vs. Group B: 12.27 ± 4.21, p < 0.001). Both regimens were well tolerated, with no significant adverse events.
Conclusions: The combination of oral diosmin/hesperidin, bromelain, and lidocaine provides superior initial symptom relief compared with nifedipine-based regimens. Lidocaine is the preferred topical agent for rapid pain management in AHD patients. Further studies are required to confirm these results.
背景：急性痔疮病（AHD）是一种常见的肛肠疾病，严重影响患者的生活质量和医疗保健系统。尽管有各种保守治疗方法，但相对疗效数据仍然有限。本回顾性研究评估了AHD的两种治疗方案，重点关注症状缓解、患者报告的结果和治疗耐受性。方法：回顾2022年10月至2024年10月在某三级保健中心治疗的123例AHD患者的病历。患者分为两组：A组口服地奥司明/橙皮苷、菠萝碱，外用利多卡因；B组口服地奥司明/橙皮苷、菠萝碱，外用硝苯地平。在基线和第7、14和21天使用痔疮疾病症状评分（HDSS）、疼痛视觉模拟量表（VAS）和痔疮疾病短期健康量表（SHS-HD）对症状进行评估。结果：两组患者在研究期间症状均有明显改善。A组疼痛减轻更快（VAS日：0.17±0.52 vs. 2.20±1.11,p）结论：与硝苯地平为主的方案相比，口服地奥司明/橙皮苷、菠萝酶和利多卡因联合使用可更好地缓解初始症状。利多卡因是AHD患者快速止痛的首选外用药物。需要进一步的研究来证实这些结果。
期刊介绍：
Since its establishment in 2003, The Surgeon has established itself as one of the leading multidisciplinary surgical titles, both in print and online. The Surgeon is published for the worldwide surgical and dental communities. The goal of the Journal is to achieve wider national and international recognition, through a commitment to excellence in original research. In addition, both Colleges see the Journal as an important educational service, and consequently there is a particular focus on post-graduate development. Much of our educational role will continue to be achieved through publishing expanded review articles by leaders in their field.
Articles in related areas to surgery and dentistry, such as healthcare management and education, are also welcomed. We aim to educate, entertain, give insight into new surgical techniques and technology, and provide a forum for debate and discussion.
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