The Effect of Topical Diltiazem on Post-Hemorrhoidectomy Pain: A Cohort Study

Background: Diltiazem is a calcium channel blocker that can prevent calcium absorption by myocytes and decrease the tone of the internal anal sphincter. Thus, it can be used for the treatment of anal fissures; however, its effect on post-hemorrhoidectomy pain is unclear. Accordingly, the current study aimed to evaluate the effect of topical diltiazem on post-hemorrhoidectomy pain. Methods: This cohort study included 50 candidates of hemorrhoidectomy referred to Shahid Mohammadi Hospital, Bandar Abbas, Iran from March 20, 2020, to March 21, 2021. First, the characteristics of the patients, including age, gender, degree of hemorrhoid, and the number of hemorrhoid pockets were recorded based on the study purpose. One group received topical diltiazem 2% three times a day for three days after hemorrhoidectomy, and the other group received Vaseline®. Both groups also received 500 mg paracetamol tablets. Post-hemorrhoidectomy pain was assessed using a numerical rating scale (NRS) by patients on the first and third days after surgery. The cumulative amount of consumed paracetamol was also noted on the third day. Results: Patients in both groups were comparable regarding age, gender, degree of hemorrhoids, and the number of pockets. There was no significant difference between groups in terms of pain on the first day after surgery (P=0.626), while the mean pain score was significantly lower in the diltiazem group on the third day compared to the placebo group (P<0.001). Finally, the cumulative amount of consumed paracetamol was significantly higher in the placebo group (P=0.001). Conclusion: Overall, topical diltiazem appears to be more effective than placebo for post-hemorrhoidectomy pain reduction.