***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 Milligan-Morgan excision haem-orrhoidectomy remains a very popular treatment modality for third and fourth degree haemorrhoids due to its cost effectiveness and good long-term results . The LigaSure tissue-sealing device is an alternative technique used in haemorrhoidectomy that has been shown to produce favourable results . The aim of this study was to assess the effectiveness of the LigaSure tissue sealing device in comparison with conventional diathermy haemorrhoidectomy Methods A prospect i ve clinical trial was conducted . Patients with newly diagnosed haemorrhoids requiring haemorrhoidectomy were r and omized to either LigaSure haemorrhoidectomy or diathermy haemorrhoidectomy . Surgical technique and postoperative care was st and ardized . Outcome measures were operative time and bleeding , postoperative pain ( measured on a visual analogue scale ) and rate of wound healing Results We r and omized 44 patients , 22 to LigaSure and 22 to diathermy ; 43 patients were evaluated . They were aged between 19 and 71 years . There were no differences in patient demographics or type of haemorrhoid being operated on .  LigaSure haemorrhoidectomy had a significantly lower mean operative time and intraoperative bleeding . At 3 weeks after surgery , haemorrhoidectomy performed with LigaSure had an odds ratio for complete epithelialization of 3.1 over diathermy ( 95 % CI 1.2–8.2 ) . There was no difference in postoperative pain Conclusion LigaSure haemorrhoidectomy is superior to diathermy for open 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 OBJECTIVES Control of postoperative symptoms is of paramount importance in proctologic surgery . Phlebotropic activity , protective effect on the capillaries and anti-inflammatory properties of the flavonoids have been reported in several studies . They have been used to treat a variety of conditions including chronic venous insufficiency , lymphedema and hemorrhoids . Numerous trials , assessing the effect of phlebotonics in treating the symptoms and signs of haemorrhoidal disease , suggest that there is a potential benefit . Our trial was conducted to evaluate whether the flavonoids reduce postoperative bleeding , pain and other symptoms after hemorrhoidectomy . PATIENTS AND METHODS We compared the results obtained in 24 patients undergoing open hemorrhoidectomy with radiofrequency scalpel .  Our study cohort was r and omized in two groups : the Group A received flavonoids in the postoperative period , the Group B has constituted the control group , without administration of study drug . Follow-up outpatient visits were performed on 7 , 15 and 30 postoperative day ( POD ) . During the visits the patients expressed trough a list of specific questions , based on a scoring system ( 1 to 10 ) , their opi-nion about the extent of postoperative symptoms as pain , bleeding , tenesmus , pruritus and perianal weight . RESULTS We observed that the results obtained after 7 days of surgery are similar in both study groups . Even after 15 and 30 days no significant changes were observed between the two groups about pain and bleeding . Instead , we observed significant differences regarding tenesmus ( group A : 8.0±1.1 vs Group B : 5.4 ± 1.5 at 15 POD , p < 0.05 ; group A : 9.1±0.8 vs Group B : 5.7 ± 0.9 at 30 POD , p < 0.05 ) , pruritus ( group A : 7.1 ± 1.4 vs Group B : 4.8 ± 1 at 15 POD , p < 0.05 ; group A : 9.5 ± 0.5 vs Group B : 6.6 ± 0.8 at 30 POD , p < 0.05 ) and perianal weight ( group A : 7.2 ± 0.9 vs Group B : 6.2 ± 0.8 at 15 POD , p < 0.05 ; group A : 9.75 ± 0.4 vs Group B : 7.3 ± 0.9 at 30 POD , p < 0.05 ) . CONCLUSIONS Our results confirm the usefulness of this drug to reduce the prevalence and the importance of post-hemorrhoidectomy symptoms and make more comfortable the postoperative period Background In the past decade , several new surgical tools have revived the hope for an improved technique to treat radically hemorrhoids with less postoperative pain . Among these radiofrequency ( RF ) , excisional surgery seems to be safe , fast , and accompanied by less postoperative pain . The aim of this study was to evaluate and compare RF ( ligasure TM ) to conventional diathermy Milligan-Morgan hemorrhoidectomy ( MMH ) . Patients and methods Between January 2003 and July 2009 , 210 symptomatic patients were r and omized to undergo RF ( 118 patients ) or diathermy MMH ( 92 patients ) . Mean follow-up was 39 ± 16 months . Clinical outcome was assessed by vali date d question naire on postoperative symptoms and satisfaction . Primary endpoints were pain and wound healing . Secondary endpoints were operative time , early and late complications ( including recurrences ) , and patient satisfaction . Data was analyzed using chi-squared test and Fisher ’s exact test . Results Despite postoperative pain was less after RF , this difference was significant only for severe pain ( expressed as VAS score > 7 ) . Significant differences were observed in terms of wound healing . The two techniques were similar in terms of early and late complications . Conclusions RF hemorrhoidectomy is followed by reduced severe pain and better wound healing . However , in our experience , this is not followed by earlier return to daily activities Background Hemorrhoid is one of the most common surgical diseases occurring in the anorectal region . In this study , we evaluated the effect of ischiorectal fossa block on alleviating  post hemorrhoidectomy pain . Methods In this study , 90 patients suffering from hemorrhoids were evaluated . They were r and omly divided into 3 groups . The first group had no block , the second group an ischiorectal block with placebo ( normal saline ) , and the third group a preemptive ischiorectal block with bupivacaine . Postoperative variables such as pain intensity , pethidine consumption , nausea , and vomiting were compared between the groups . Results The postoperative pain score in group 1 was 8.5 ± 1.3 and 8.1 ± 0.9 ( P = NS ) in group 2 . The post operative analgesic dem and was 3.1 ± 1.5 and 3.3 ± 1.8 hours in groups 1 and 2 , respectively ( P = NS ) . The post operative pain score and analgesic dem and were 4.2 ± 2.1 and 9.3 ± 2.7 hours , respectively , in group 3 ( P < 0.0001 ) . Conclusions Preemptive ischiorectal block reduces the posthemorrhoidectomy pain and opioid dem and INTRODUCTION Hemorrhoidal disease occurs in 50 % of people aged > 40 years and is the most common reason for anorectal surgery .  Pain is the main complication . Multiple topical and systemic drugs have been investigated for pain control , but there is no ideal treatment . Metronidazole has been shown to decrease postoperative pain but is not used widely . OBJECTIVE To evaluate the effect of oral metronidazole versus placebo and to assess postoperative pain following hemorrhoidectomy . MATERIAL AND METHODS Controlled clinical trial in adult patients who underwent elective hemorrhoidectomy for grade III/IV hemorrhoids . Patients were assigned to receive metronidazole ( 500 mg q8 h orally ; study group , SG ) or placebo ( control group , CG ) for 7 days after surgery . Pain was assessed using a visual analog scale after surgery . Analgesic administration ( time and use of analgesics ) and resumption of daily life activities were also assessed . RESULTS Forty-four patients were included , 22 in each group . Postoperative pain differed significantly between the SG and CG at 6 h ( 3.86 ± 0.56 , 6.64 ± 1.49 ) , 12 h ( 5.59 ± 1.33 , 8.82 ± 0.79 ) , 24 h ( 6.86 ± 1.49 , 9.73 ± 0.45 ) , day 4 ( 5.32 ± 2.10 , 9.50 ± 0.59 ) , day 7 ( 3.14 
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Conclusion Pudendal nerve block , with or without general anaesthesia , is recommended for all patients undergoing haemorrhoidal surgery .
Either closed haemorrhoidectomy , or open haemorrhoidectomy with electrocoagulation of the pedicle is recommended as the primary procedure .