Comparative evaluation of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.

Vundavalli Sattibabu, Satish Dalal, Mahavir Singh, Chisel Bhatia


Background: Anal fissure is one of the most common anorectal problem and presents as a tear in the anoderm distal to the dentate line. It is a common proctologic problem and accounts for 10-15% of proctological consultations and seen frequently in young and middle-aged patients. Presently wide range of medical and surgical treatment options were available. Present study was aimed to evaluate the therapeutic efficacy of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.

Methods: In the present study, a total of 100 patients diagnosed with acute fissure in ano were randomly allocated into two groups (I, II) of 50 patients each and were managed by local application of 5% Lignocaine (LIG) ointment and a combination of both 0.2% Glyceryl trinitrate (NTG) and 5% Lignocaine (LIG) ointment respectively.

Results: In the present study, the incidence of anal fissure was higher in males than in females with mean age of occurrence of 35.12 years. Pain was the most common symptom to present with. After six weeks, complete pain relief was seen in most of the patients and was comparable in both the groups but healing was superior in group II when compared to group I. Headache and dizziness were the side effects only noticed in group II.

Conclusions: To conclude the study, we can say that the treatment of anal fissure is becoming increasingly medical as it can be carried out on outpatient basis and is cost effective and there is no loss of man hours. Lignocaine may be preferred as the first line treatment as there are no side effects and if there is failure to heal then we can prescribe the combination of both drugs owing to their risk benefit ratio.


Acute fissure in ano, Healing, LIG, NTG, Pain relief

Full Text:



Zaghiyan KN, Fleshner P. Anal Fissure. Clin Colon Rectal Surg. 2011;24:22-30.

Herzig DO, Lu KC. Surgical clinics of North America Anorectal disease. Anal Fissure. 2010;90:33.

Bennett RC, Goligher JC. Results of internal sphincterotomy for anal fissure. BMJ. 1962;2:1500-3.

Nzimbala MJ, Bruyninx L. Chronic anal fissure from suspected adult sexual abuse in a traumatic anal sex practice patient. Acta Chir Belg. 2007;107:566-9.

Kocher HM, Steward M, Leather AJ, Cullen PT. Randomized clinical trial assessing the side effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure. Br J Surg. 2002;89(4):413-7.

Lund JN, Armitage NC, Scholefield JH. Use of glyceryl nitrate in treatment of anal fissures. Br J Surg. 1996;83:776-7.

Mann MS, Mishra R, Thomas S, Hadke NS. Randomized, double blind trial comparing topical nitroglycerine with xylocaine and proctosedyl in primary idiopathic chronic anal fissure. Ind J Gastroenterol. 2004;23(3):91-3.

Lund JN, Parson SL, Scholefield JH. Spasm of the internal anal sphincter in anal fissure: cause or effect? (abstract). Gastroenterol. 1996:110:A711.

Sanei B, Mahmoodieh M, Masoudpour H. Comparison of topical glyceryltrinitrate with diltiazem ointment for treatment of anal fissure: a randomized clinical trial. Acta Chir Belg. 2009;109(6):727-30.