***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Spasm through the internal anal sphincter is one of the supposed causes for pain after hemorrhoidectomy , a common and distressing experience . We hypothesized that the addition of topical nifedipine to lidocaine would improve pain control by causing a relaxation of the smooth muscle of the internal anal sphincter . METHODS We conducted a multicentre r and omized , double-blind trial to compare the efficacy of 0.3 % nifedipine and 1.5 % lidocaine ointment versus 1.5 % lidocaine ointment alone in reducing pain after hemorrhoidectomy . A physician unaware of the treatment arm measured pain by use of the Analogue Chromatic Continuous Scale ( ACCS ) at baseline ; soon after surgery ; at 2 , 4 , 6 , 8 and 24 hours after surgery ; on day 7 after surgery ; and at a final visit 14 days after surgery . The physician also noted the time to first analgesic administration within 24 hours after surgery . RESULTS In all , 135 patients per group participated ( 270 total ) . Evaluation of the delta ACCS score versus basal value , a covariate for rescue analgesic administration time , revealed better pain control in the group that received nifedipine with lidocaine at 6 hours after surgery and on day 7 ( p < 0.011 and p < 0.054 , respectively ) . We noticed no difference between groups for time of administration of rescue analgesic , blood pressure , heart rate or frequency of headache . CONCLUSION Although there was no difference between groups for time of administration of rescue analgesic after open hemorrhoidectomy , the patients ' assessment of pain using ACCS showed that the use of topical nifedipine with lidocaine may provide a slight significant difference in favour of the study group at 6 hours and at day 7 after surgery . Narcotic analgesics and nonsteroidal anti-inflammatory drug administration should continue to be recommended . Further research focusing on these outcomes is warranted Background Atorvastatin is a 3-hydroxy-3-methylglutaryl coenzyme A ( HMG CoA ) reductase inhibitor widely used in treatment of hypercholesterolemia and prevention of coronary heart disease and has various pleiotropic effects . In this study , the efficacy of atorvastatin emulgel ( 2 % ) in reducing postoperative pain at rest , pain during defecation and analgesic requirement after open hemorrhoidectomy was investigated . Methods A total of 66 patients with third- and fourth-degree hemorrhoids undergoing open hemorrhoidectomy were included in this prospect i ve , double-blind , r and omized controlled trial . The patients were r and omly assigned to either atorvastatin emulgel or placebo immediately after surgery and then every 12 h for 14 days . The primary outcomes were intensity of pain at rest and during defecation , measured with a visual analog scale , and the analgesic requirement , measured by amount of pethidine and acetaminophen consumption , and percent of wound healing . Results There was no significant difference in the average postoperative pain scores in the first 48 h ( P12h = 1 , P24h = 0.128 and P48h = 0.079 ) after the surgery between the two groups , but at the week 1 the pain scores during defecation were considerably lower in the atorvastatin group than in placebo group ( P = 0.004 ) , which also was the same at the week 2 ( P = 0.03 ) . There was no significant difference in the average pethidine and acetaminophen ( mg ) administration at 12 h and 24 h between the two groups after surgery . Regarding the data about wound healing , at the week two the healing was much better in the treatment group than it was in control group and the difference was statistically significant ( P = 0.04 ) . Conclusions Compared with placebo , atorvastatin emulgel reduced postoperative pain at rest and on defecation and could improve the healing process after open hemorrhoidectomy . Trial registration numberI RCT 201404013014N8 Objective To determine whether a combination of topical anesthetic ( EMLA ) and local injection with lidocaine is better than lidocaine alone for  pain relief  after Ferguson hemorrhoidectomy . Methods Sixty patients scheduled for hemorrhoidectomy were r and omized into 2 groups : ( 1 ) control group ( CG , n=30 ) received neomycin ointment ( 5 g ) , and ( 2 ) EMLA group ( EG , n=30 ) received EMLA ( 5 g ) , both agents applied topically after surgery . Before the surgical incision was made , lidocaine ( 10 mL of a 1 % solution ) was locally injected into all 60 patients . After surgery , analgesics were provided when necessary . The visual analog scale score was recorded at 4 time points : ( 1 ) upon arrival in the postanesthesia room , ( 2 ) 2 hours after arriving in the postanesthesia room , ( 3 ) between 9 and 10 PM on the first postoperative evening , and ( 4 ) on the first postoperative morning . The frequency of meperidine requests , 1-time catheterizations for urinary retention , and patient satisfaction with postoperative pain management , were also recorded . Results The median visual analog scale scores and cumulative dosages of meperidine were significantly lower in the EG than the CG ( P<0.05 ) . Patient satisfaction with postoperative pain control was also significantly higher in the EG than the CG ( P<0.01 ) . No systemic complications occurred . Discussion EMLA is considered a breakthrough in cutaneous analgesia , capable of reducing pain in many cutaneous procedures . Because Ferguson hemorrhoidectomy has been performed for years with ongoing concerns over postoperative pain , we felt that using EMLA could lower postoperative pain intensity and the number of requests for additional medication Purpose We compared the efficacy and side effects of diclofenac and a topical eutectic mixture of local anesthetics ( EMLA ) for pain relief  after hemorrhoidectomy . Methods Ninety patients , nominated for elective hemorrhoidectomy , were recruited for this r and omized clinical trial and were r and omly categorized into three groups ( 30 patients in each group ) . After surgery , the patients in the first group received one 100 mg diclofenac suppository , those in the second group received 5 g of EMLA , and those in the third group received 5 g of petrolatum ointment ( control group ) . The pain intensity was measured using a visual analog scale ( VAS ) . Twenty-five mg of intramuscular pethidine was administered upon the patient ’s request . Pain measurements were performed on the patient ’s transfer to the recovery ward , 2 h after surgery , the evening and the morning after surgery . Results The EMLA group yielded the lowest VAS score on transfer to recovery and at 2 h after surgery ( p < 0.05 ) . The diclofenac group reported the lowest VAS score in the evening and the morning after surgery ( p < 0.05 ) . Conclusions Topical use of an EMLA cream is appropriate for short-term pain control following hemorrhoidectomy , while diclofenac yields a more sustainable pain control PURPOSE : Fissure-in-ano is characterized by pain , bleeding , and internal anal sphincter hypertonicity . Spasm of the internal sphincter also plays a role in hemorrhoidal disease and may be a source of anal pain after hemorrhoid surgery . Inducing sphincter relaxation with a nitroglycerin ointment has shown promise in healing anal fissures and relieving symptoms of pain . Our study attempts to test the hypothesis that topical nitroglycerin applied to the perianal region is beneficial in reducing pain after hemorrhoidectomy . METHODS : After hemorrhoidectomy 39 patients were r and omly assigned to receive 0.2 percent nitroglycerin ointment ( n=19 ) or placebo ( n=20 ) . Ointments were applied to the perianal region three times daily for seven days . Patients were prescribed hydrocodone bitartrate to take as needed . Visual analog scales were used to measure postoperative pain intensity and ointment benefits . Patients completed question naires to record medication morbidity and number of prescribed or nonprescribed medications taken . RESULTS : Patients using nitroglycerin had less pain and greater benefit from ointment than those did in the placebo group , but differences were not significant . Narcotic use was higher in the placebo group when considered on a daily basis , but was statistically significant on the second postoperative day only ( P<0.05 ) . Morbidity from ointment application was significantly higher in the nitroglycerin group ( P<0.002 ) and included a headache in 8 of 19 patients . Nonsteroidal anti-inflammatory drugs and acetaminophen were not prescribed , but were taken more frequently in nitroglycerin patients ( P<0.0003 ) . CONCLUSION : Perianal application of 0.2 percent nitroglycerin ointment after hemorrhoidectomy significantly reduced narcotic requirements on the second postoperative day . Headaches and a subsequent need for nonnarcotic medications may limit benefits of nitroglycerin Background and Objectives : Hemorrhoidectomy usually leads to severe postoperative pain that often causes urinary retention . Topical EMLA cream ( lidocaine 2.5 % and prilocaine 2.5 % ) has been used extensively in the clinical setting . This prospect i ve study tested the effectiveness of EMLA cream for postoperative pain control after hemorrhoidectomy . Methods : Thirty patients admitted for hemorrhoidectomy were enrolled and r and omly assigned into either a control group ( n = 15 ) or EMLA group ( n = 15 ) . Postoperatively , the control group received approximately 5 g of neomycin ointment , and the EMLA group received approximately 5 g of EMLA . A visual analog scale ( VAS ) score was recorded on arrival in the postanesthesia recovery unit ( PAR ) , after 2 hours in the PAR , on the first postoperative evening , and on the first postoperative morning . The requested frequency and dosage of meperidine , the first spontaneous voiding time , the frequency of single urinary catheterization , and a patient satisfaction score were also obtained . Results : The VAS score and frequency and dosage of meperidine injections were significantly lower in the EMLA group than in the control group ( P < .01 ) . The voiding time was significantly later in the control group ( P = .04 ) . The frequency of single catheterization was significantly lower in the EMLA group than in the control group ( P = .03 ) . Patient satisfaction with postoperative pain control was significantly higher in the EMLA group than in the control group ( P < .01 ) . No systemic complications were observed . Conclusions : Topical EMLA cream decreased pain intensity and meperidine requests , reduced the frequency of single catheterizations , and improved patient satisfaction  with postoperative pain management after hemorrhoidectomy in adults AIM To assess the efficacy of internal sphincterotomy compared with application of topical 2 % Diltiazem ointment  after hemorrhoidectomy for pain  relief . SETTING S AND DESIGN Prospect i ve r and omized study . MATERIAL S AND METHODS In an 18-month period , 108 subjects with uncomplicated Grade 3/ 4 hemorrhoids were enrolled in the study and were r and omized into two equal groups : Subjects in Group A underwent internal sphincterotomy at time of primary surgery while those in Group B received 1 g of 2 % Diltiazem ointment locally , thrice daily for seven days . Postoperative pain perception was measured using visual analog score ( VAS ) and on the basis of number of analgesic tablets ( Tab tramadol 50 mg ) required in each group . Time to discharge , time to return to work and incidence of complications measured and compared . STATISTICAL ANALYSIS USED Statistical techniques applied were Student T test , Chi-square and Fisher 's Exact Test . RESULTS There were 102 analyzable subjects ( Group A : 50 and Group B : 52 ) . The mean VAS score was significantly less in the internal sphincterotomy group from the fourth postoperative day onwards compared to topical Diltiazem ( 2.23 vs. 3.72 ; P = 0.031 ) . Similarly , the mean requirement of analgesic tablets [ 10.54 vs. 15.40 ; P = 0.01 ] was much lower in Group A. There was no significant difference in terms of time to discharge and time to return to work between the two groups . The incidence of complications was more with the internal sphincterotomy group ( 11.5 % vs. 3 % ; P = 0.488 ) . CONCLUSIONS In patients undergoing hemorrhoidectomy , addition of surgical internal sphincterotomy results in lesser pain in the postoperative period as compared to those receiving topical application of Diltiazem 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 prospect i ve r and omized double-blind clinical study conducted at Sawai Man Singh Hospital , Jaipur , from May 2016 to May 2017 . Sixty patients , who had undergone hemorrhoid , were r and omly assigned to receive 2 % diltiazem ointment ( n = 30 ) or a placebo ointment ( n 
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There were mixed significant changes in pain for GTN compared with placebo .
Conclusion Topical diltiazem , metronidazole and sucralfate appear to significantly reduce pain at various timepoints following excisional haemorrhoidectomy .
GTN had mixed evidence .
Several single trials identified other promising topical analgesics