Efficacy of 0.4% Glyceryl Trinitrate Ointment and 2% Lidocaine Gel in the Treatment of Anal Fissure in Children: A Comparative Study

Background: Anal fissures in children cause painful anal canal tears, requiring careful management to prevent prolonged discomfort and complications. Though 0.4% Glyceryl Trinitrate (GTN) or 2% Lidocaine gel show promise in adults, their effectiveness and safety in pediatrics remain uncertain. This study aimed to compare the efficacy of 0.4% Glyceryl Trinitrate ointment and 2% Lidocaine gel in the treatment of anal fissures in children. Methods: This prospective, comparative study was conducted in the Outpatient Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2022 to August 2023. This study enrolled 52 anal fissure patients aged 3-16 years of both genders. They were divided into two groups: Group I received 0.4% GTN ointment, and Group II received 2% Lidocaine gel. Ethical approval was obtained, and SPSS 23.0 was used. Results: Most (80.8%) acute anal fissure patients achieved symptomatic improvement and complete healing with 0.4% GTN, whereas 26.9% improved with 2% lidocaine gel (p<0.05). Improvement took over a month in 52.4% (group I) and 57.1% (group II) (p>0.05). All experienced perianal pain. Constipation affected 88.5% (group I) and 73.1% (group II). Headache (15.4%) and postural hypotension (7.7%) occurred in group I. Conclusion: Chemical sphincterotomy is an effective first-line treatment for anal fissures. Both glyceryl trinitrate (GTN) and 2% lidocaine gel aid management, but topical GTN provides superior healing, symptom relief, and sustained improvement with minimal, manageable side effects.