Topical Sucralfate Reduces Pain, Improves Wound Healing Post-Hemorrhoidectomy

Reno Rudiman, MD

Topical sucralfate improved wound healing, alleviated pain, and minimized the use of pethidine and diclofenac compared to placebo in patients with complications following hemorrhoidectomy, according to a new systematic review.

For decades, the synthetic opioid analgesic drug pethidine had been used to treat moderate to severe acute pain related to post-operative patients and post-open hemorrhoidectomy, as has the non-steroidal anti-inflammatory drug diclofenac.

Similarly, sucralfate has been used to protect and cure gastric mucosa in acid peptic disease and promotes the binding of epidermal growth at a quicker pace. Despite this, there was no evidence of its efficacy for post-hemorrhoidectomy pain reduction from a systematic review.

With this study, an investigative team led by Reno Rudiman, MD, of the Division of Digestive Surgery at Padjadjaran University in Indonesia, considered the efficacy of topical sucralfate ointment compared to placebo for reducing post-operative pain and improving wound healing post-hemorrhoidectomy.

Rudiman and colleagues performed a systematic review of multiple English-language databases including PubMed, Google Scholar, Europe PMC, and ClinicalTrials.gov using key search terms including “topical”, “ointment”, “cream”, “sucralfate”, “hemorrhoid”, “hemorrhoidectomy”, and more. Two authors were responsible for data extraction, which included everything from the general structure of the study to sucralfate dosing.

The team investigated the influence of topical sucralfate on pain score post-operatively including 24 hours, 7 days, and 14 days. The use of pethidine and diclofenac and wound healing compared to placebo were also considered.

Of the 234 studies that were considered during the review, 6 were deemed eligible for inclusion. Among them, 4 were double-blind RCT, 1 was single-blind RCT, and the remaining article did not specify the blinding methods. A total of 439 patients were featured in these studies.

Samples in these studies had grade III and IV hemorrhoids, and the dose for topical sucralfate used ranged from 7-10% post-surgery.

Broadly, topical sucralfate demonstrated significant post-operative outcomes on the visual annual scale (VAS) in 23 hours (P=.005), 7 days (P<.001), and 14 days (P<.0001). Similarly, pethidine and diclofenac usage was minimized as patients continued to use topical sucralfate, and significant outcomes were observed for wound healing rates at 28-post operation (RR 1.45 95% CI 1.25–1.68) (P < .00001).

Across all 6 studies, sucralfate was associated with pain reduction, which contradicted a previous systematic review that found the topical ointment had a similar effect on pain score reduction to placebo on days 7 and 14. However, results of the current study could not be concluded as there was a small number of studies and participants, in addition to high heterogeneity.

“Topical sucralfate improved pain scores, accelerated wound healing rate, and reduced analgesic usage,” the team wrote. “Consequently, topical sucralfate is a safe, feasible, and favorable treatment after hemorrhoidectomy.”

The study, "The efficacy of topical sucralfate in improving pain and wound healing after haemorrhoidectomy procedure: A systematic review, meta-analysis, and meta-regression of randomised clinical trials," was published online in the International Wound Journal.