Topical lidocaine/diltiazem significantly improves pain after Rubber Band Ligation of Hemorrhoids

A new study by Allan Kwok and team showed that topical lidocaine enhances analgesia in the short term, while a combination of lidocaine and diltiazem improves analgesia and increases patient satisfaction after hemorrhoid banding. The findings of this study were published in Diseases of the Colon & Rectum. 

Rubber band ligation of hemorrhoids produces less pain than excisional hemorrhoidectomy, however many patients still have severe post-procedure discomfort. In order to find out whether topical lidocaine, with or without diltiazem, is more efficient than a placebo for analgesia following hemorrhoid banding, this study was carried out.

This investigation was a prospective, randomized, double-blinded, placebo-controlled experiment. Patients were given a placebo, 2% lidocaine, or 2% lidocaine plus 2% diltiazem. In Australia, this study was carried out at two public teaching hospitals affiliated with universities and two private hospitals. Consecutive hemorrhoid banding patients under the age of 18 were chosen. Topical ointments were used post-procedure three times each day for five days as an intervention. The primary end measures included the visual analogue pain score, the use of opiate analgesics, and patient satisfaction.

The key findings of this study were:

99 suitable patients out of 159 total were randomized (33 in each group). 

Comparing the lidocaine and lidocaine/diltiazem groups to the placebo group, the pain ratings were lower at an hour (OR 4.15 [1.12-15.41] p = 0.03) and (OR 3.85 (1.05-14.11) p = 0.04). 

Patients in the group that received lidocaine/diltiazem reported higher levels of satisfaction (OR 3.82 [1.28-11.44], p = 0.02) and were also more likely to tell others about the procedure (OR 9.33 [1.07-81.72], p = 0.04). 

Compared to the placebo group, patients receiving lidocaine/diltiazem needed around 45% less overall and in-hospital analgesia. 

None of the groups' complications varied from one another.

In conclusion, following rubber band ligation of hemorrhoids, topical lidocaine/diltiazem ointment-associated improved analgesia was seen.

Reference: 

Kwok, A. M. F., Smith, S. R., Zhao, J., Carroll, R., Leigh, L., & Draganic, B. (2023). Topical Lidocaine or Lidocaine/Diltiazem Ointment Following Rubber Band Ligation of Hemorrhoids: A Prospective Three-Armed Randomized Controlled Trial. In Diseases of the Colon & Rectum: Vol. Publish Ahead of Print. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/dcr.0000000000002774