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Topical metronidazole (10 percent) has been previously demonstrated to decrease postoperative pain after hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole (10 percent) in reducing postoperative and after-defecation pain of hemorrhoidectomy.A double-blind, randomized trial was conducted to compare posthemorrhoidectomy pain with use of topical metronidazole (10 percent)vs.placebo carrier, applied to surgical site. Forty-seven patients were randomly allocated to receive metronidazole (n = 25) or placebo (n = 22). Pain was assessed using a visual analog scale preoperatively and on postoperative hours 6 and 12 and at days 1, 2, 7, and 14. The use of narcotic, additional analgesics, and complications were recorded. (Pain scores were calculated and compared with baseline values and control group (ttest, SPSS ver.10).Patients in the topical metronidazole group had significantly less postoperative pain than those in the placebo group up to day 14 (P ≤ 0.04). There was no significant difference in narcotic analgesic requirements between groups, except on hour 12 (P < 0.05). In the metronidazole group, after-defecation pain was ranked significantly lower at day 2 (P = 0.016) and patients required fewer additional analgesics postoperatively on days 2 and 7 (P ≤ 0.04).These finding indicate that topical 10 percent metronidazole significantly reduce posthemorrhoidectomy discomfort, and postoperative defecation pain is reduced compared with that of the placebo control group.