Comparison of topical anesthetic cream (EMLA) and diclofenac suppository for pain relief after hemorrhoidectomy: a randomized clinical trial.

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 randomized clinical trial and were randomly 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.