Comparison of the Efficacy of Oral Magnesium with Oral Ketorolac for Postoperative Pain Management in Anorectal Surgery: A Double-blinded Randomized Clinical Trial.

BACKGROUND: Due to the presence of postoperative pain in patients undergoing anorectal surgery, and since the pain affects the quality of life of patients, we aimed to compare the analgesic effectiveness of oral magnesium with oral ketorolac to choose the right analgesic drug for these patients. METHODS: This study was a double-blind, randomized clinical trial performed on 104 candidates undergoing anorectal surgery. Patients were randomly divided into two groups. Group 1 received oral magnesium (250 mg daily), and group 2 received oral ketorolac (10 mg daily). The medicine was given to the patient 2 hours after the operation and every 12 hours for 10 days. Pain measurements were recorded at 24-hour intervals after surgery based on the visual analog scale and numerical rating scale. RESULTS: This study found that postoperative pain was reduced in patients taking magnesium tablets, similar to the ketorolac group. A similar decreasing trend was observed in the group receiving ketorolac; however, the reduction was more pronounced in the magnesium group and was statistically significant on days 1, 3, and 5 (p < 0.001). However, insignificant differences were noted between the two groups on the seventh (p = 0.093) and tenth (p = 0.088) postoperative days. CONCLUSION: Taking magnesium tablets after surgery has a suitable analgesic effect, which is similar to oral ketorolac tablets from the fifth day onwards, but in the initial days, it is less effective than ketorolac statistically.

Use of Mesenchymal Stem Cells in Crohn's Disease and Perianal Fistulas: A Narrative Review.

Crohn's Disease (CD), which usually leads to anal fistulas among patients, is the most important inflammatory bowel disease that causes morbidity in many people around the world. This review article proposes using MSCs as a hopeful therapeutic strategy for CD and anal fistula treatment in both preclinical and clinical conditions. Finally, darvadstrocel, a cell-based medication to treat complex anal fistulas in adults, as the only European Medicines Agency (EMA)-approved product for the treatment of anal fistulas in CD is addressed. Although several common therapies, such as surgery and anti-tumor necrosis factor-alpha (TNF-α) drugs as well as a combination of these methods is used to improve this disease, however, due to the low effectiveness of these treatments, the use of new strategies with higher efficiency is still recommended. Cell therapy is among the new emerging therapeutic strategies that have attracted great attention from clinicians due to its unique capabilities. One of the most widely used cell sources administrated in cell therapy is mesenchymal stem cell (MSC). This review article will discuss preclinical and clinical studies about MSCs as a potent and promising therapeutic option in the treatment of CD and anal fistula.