COMPARISON OF EFFICACY OF TOPICAL 0.2% GLYCERYL TRINITRATE VS. LOCAL OINTMENT (LIGNOCAINE) IN THE MANAGEMENT OF ACUTE ANAL FISSURE

Abstract

Objective: To compare the efficacy of 0.2% topical glyceryl trinitrate versus local ointment in the management of acute anal fissure."

Methods: This randomized controlled trial was conducted at the Department of Surgery, GMMC/Civil Hospital, Sukkur, between January 1^st 2025  to 1^st  june  2025. Seventy patients with acute anal fissures were enrolled using a non-probability consecutive sampling technique. Ethical approval was obtained, and informed consent was collected from all participants. Inclusion criteria included patients with acute anal fissures, while those with ischemic heart disease, migraine, pregnancy, perianal fistula, perianal abscess, inflammatory bowel disease, or a recent hemorrhoidectomy were excluded. Demographic data, including age, sex, weight, height, and medical history (smoking, diabetes, hypertension, constipation), were collected. Patients were randomly assigned to two groups: Group A received 0.2% glyceryl trinitrate ointment, and Group B received local lignocaine compound ointment, both applied twice daily for 8 weeks. After 8 weeks, patients were reassessed for fissure healing (epithelialization) and pain relief (VAS score < 2). Non-healing patients were considered non-responders. Data were recorded using a proforma, and outcomes documented.

Results: Out of 70 patients with acute anal fissures, 40 were male and 30 were female, with a mean age of 42.93 ± 12.75 years. Patients were randomly and equally divided into two groups (35 each): Group A received 0.2% glyceryl trinitrate ointment, while Group B received local lignocaine compound ointment. After 8 weeks, 29 patients (82.9%) in Group A achieved complete healing, compared to only 17 patients (48.6%) in Group B. This difference was highly significant (p = 0.003). Additionally, Group A had significantly lower mean pain scores (3.00 ± 1.16) compared to Group B (5.60 ± 1.09), with a mean difference of -2.60 (p = 0.000). Subgroup analyses showed that glyceryl trinitrate was more effective in both males and females, across various residence types, and for patients with diabetes and constipation. Furthermore, patients with sedentary lifestyles in Group A had significantly higher healing rates (17 out of 20) compared to Group B (12 out of 25) (p = 0.010). Dietary patterns, particularly home-made food, were also associated with better outcomes for Group A. These findings emphasize the greater efficacy of glyceryl trinitrate in healing acute anal fissures and reducing pain.

Conclusion: The study provides adequate evidence that 0.2 % glyceryl trinitrate is much deeper compared to the local lignocaine ointment in the healing of acute anal fissures. GTN is more effective in terms of complete healing and better analgesia, and also can support a wide range of patients and clinical variables. These findings are consistent with other existing data, which reveal that GTN is an effective form of treatment. Future research aimed at enhancing the treatment process will also rely on studies examining long-term outcomes and potential side effects.