Topical Sucralfate Ointment for Postoperative Pain Reduction after Hemorrhoidectomy: Systematic Review
Abstract
ABSTRACT
BACKGROUND
Topical sucralfate ointment recently shows efficacy for postoperative pain reduction after hemorrhoidectomy. However, no systematic review compares the efficacy between topical sucralfate ointment and other topical treatments for postoperative pain reduction after hemorrhoidectomy.
METHODS
Three independent reviewers systematically searched through electronic databases including Cochrane library, Pubmed, Trip Database and Scopus using the term “hemorrhoidectomy” or “post hemorrhoidectomy pain” together with “topical sucralfate ointment”. Furthermore, we also sought for additional studies using a hand searching to identify all relevant randomized controlled trials (RCT) that comparing effect of topical sucralfate ointment and other topical treatments for postoperative pain reduction after hemorrhoidectomy. We included RCT with patients undergoing hemorrhoidectomy and using topical sucralfate ointment. We used Jadad score and The Cochrane Collaboration’s Tool for Assessing Risk of Bias to assess the quality of the included RCTs. Furthermore, we extracted the data from the included trials and we later performed the meta-analysis where possible.
RESULTS
Two RCTs were included in the meta-analysis with 138 patients undergoing hemorrhoidectomy; topical sucralfate ointment (N=69) and placebo (N=69). Topical sucralfate ointment had similar effect for pain score reduction to that of placebo at day 7 after hemorrhoidectomy (mean difference (MD) -0.47; 95% confidence interval (CI), -2.01 to 1.07; I2 =88%) and at day 14 after hemorrhoidectomy (MD -0.16; 95% CI, -1.98 to 1.67; I2=92%). Furthermore, patients in sucralfate group requested less daily amount of diclofenac than in placebo group at day 7 after hemorrhoidectomy (MD -64.58; 95% CI, -110.61 to -18.56; I2=92%), but not at day 14 after hemorrhoidectomy (MD -54.25; 95% CI, -113.51 to 5.01; I2=96%).
CONCLUSION
In patients undergoing hemorrhoidectomy, comparing efficacy between using topical sucralfate ointment and placebo for postoperative pain reduction after hemorrhoidectomy at day 7 cannot be concluded as our review had low volume of studies and participants as well as high heterogeneity.
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