Systematic review and meta‐analysis of the role of metronidazole in post‐haemorrhoidectomy pain relief

Aim Conventional haemorrhoidectomy is still considered the reference standard for the management of severe or recurrent haemorrhoids. Pain is reported by patients to be the most common postoperative complication. Although the literature lacks a consensus on its effectiveness, metronidazole is often used to reduce postoperative pain. We have performed a meta‐analysis of all randomized controlled trials (RCTs) that investigated the use of metronidazole for pain relief after haemorrhoidectomy. Method A systematic review was undertaken in accordance with the PRISMA protocol using the MESH headings ‘haemorrhoidectomy’, ‘hemorhoidectomy’, ‘hemorrhoidectomy’, ‘haemorrhoid’, ‘metronidazole’, ‘Flagyl®’ ‘antibiotic’ and ‘pain’. The search returned 421 articles of which eight were RCTs suitable for inclusion in the review with a total population of 437 patients. The outcomes of interest were postoperative pain intensity on days 1, 2 and 7 and on first defaecation as measured using a visual analogue scale. Results The meta‐analysis demonstrated a significant reduction in postoperative pain for patients treated with metronidazole with a reduced mean difference for the metronidazole group on day 1 of −1.42 (95% CI: −2.14 to −0.69, P = 0.0001), on day 2 of −1.43 (95% CI: −2.45 to −0.40, P = 0.006) and on day 7 of −2.40 (95% CI: −3.10 to −1.71, P