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Published in: World Journal of Surgery 1/2013

01-01-2013

Efficacy of 10 % Sucralfate Ointment in the Reduction of Acute Postoperative Pain After Open Hemorrhoidectomy: A Prospective, Double-Blind, Randomized, Placebo-Controlled Trial

Authors: Shahram Ala, Majid Saeedi, Fariborz Eshghi, Mohamadreza Rafati, Vahid Hejazi, Roja Hadianamrei

Published in: World Journal of Surgery | Issue 1/2013

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Abstract

Background

The aim of the present study was to evaluate the efficacy of 10 % sucralfate ointment in the reduction of acute postoperative pain after open hemorrhoidectomy.

Methods

A total of 48 patients (24 men and 24 women) between 20 and 70 years of age who underwent open hemorrhoidectomy were included in this prospective, double-blind, randomized, controlled trial and were randomly divided into two groups (24 in each group), receiving either sucralfate ointment or placebo immediately after surgery and then every 12 h for 14 days. The primary outcome measure was pain intensity measured by a visual analogue scale at different time points after hemorrhoidectomy.

Results

The sucralfate group had significantly less pain than the placebo group at 24th h and the 48th h after hemorrhoidectomy (4 ± 1.14 vs 5.08 ± 0.97; P = 0.001 and 3 ± 0.72 vs 4.41 ± 0.8; P < 0.001, respectively), and they consumed lower amounts of analgesics at the same time intervals (12.50 ± 16.48 vs 21.87 ± 15.30 mg of pethidine; P = 0.047 and 152 ± 23 vs 172 ± 29 mg of diclofenac; P = 0.009, respectively). The same trend continued until the end of the trial.

Conclusions

Sucralfate ointment reduced the acute postoperative pain after hemorrhoidectomy.
Literature
1.
go back to reference Holzheimer RG (2004) Hemorrhoidectomy: indications and risks. Eur J Med Res 9:18–36PubMed Holzheimer RG (2004) Hemorrhoidectomy: indications and risks. Eur J Med Res 9:18–36PubMed
2.
go back to reference Nisar PJ, Scholefield JH (2003) Managing hemorrhoids. Br Med J 327:847–851CrossRef Nisar PJ, Scholefield JH (2003) Managing hemorrhoids. Br Med J 327:847–851CrossRef
3.
go back to reference You SY, Kim SH, Chung CS et al (2005) Open vs. closed hemorrhoidectomy. Dis Colon Rectum 48:108–113PubMedCrossRef You SY, Kim SH, Chung CS et al (2005) Open vs. closed hemorrhoidectomy. Dis Colon Rectum 48:108–113PubMedCrossRef
4.
go back to reference Arbman G, Krook H, Haapaniemi S (2000) Closed vs. open hemorrhoidectomy—Is there any difference? Dis Colon Rectum 43:31–34PubMedCrossRef Arbman G, Krook H, Haapaniemi S (2000) Closed vs. open hemorrhoidectomy—Is there any difference? Dis Colon Rectum 43:31–34PubMedCrossRef
5.
go back to reference Shalaby R, Desoky A (2001) Randomized clinical trial of stapled versus Milligan-Morgan hemorrhoidectomy. Br J Surg 88:1049–1053PubMedCrossRef Shalaby R, Desoky A (2001) Randomized clinical trial of stapled versus Milligan-Morgan hemorrhoidectomy. Br J Surg 88:1049–1053PubMedCrossRef
6.
go back to reference Uzzaman MM, Siddiqui MRS (2011) A brief literature review on the management of post-hemorrhoidectomy pain. Surg Tech Dev 1(e-32):82–87 Uzzaman MM, Siddiqui MRS (2011) A brief literature review on the management of post-hemorrhoidectomy pain. Surg Tech Dev 1(e-32):82–87
7.
go back to reference Kisli E, Baser M, Güler O et al (2005) Comparison of the analgesic effect of betamethasone and diclofenac potassium in the management of postoperative hemorrhoidectomy pain. Acta Chir Belg 105:388–391PubMed Kisli E, Baser M, Güler O et al (2005) Comparison of the analgesic effect of betamethasone and diclofenac potassium in the management of postoperative hemorrhoidectomy pain. Acta Chir Belg 105:388–391PubMed
8.
go back to reference Goldstein ET, Williamson PR, Larach SW (1993) Subcutaneous morphine pump for postoperative hemorrhoidectomy pain management. Dis Colon Rectum 36:439–446PubMedCrossRef Goldstein ET, Williamson PR, Larach SW (1993) Subcutaneous morphine pump for postoperative hemorrhoidectomy pain management. Dis Colon Rectum 36:439–446PubMedCrossRef
9.
go back to reference Jaffe JH, Martin WR (1985) Opioid analgesics and antagonists. In: Goodman LS, Gilman A (eds) The pharmacologic basis of therapeutics, 7th edn. Macmillan, New York, pp 491–531 Jaffe JH, Martin WR (1985) Opioid analgesics and antagonists. In: Goodman LS, Gilman A (eds) The pharmacologic basis of therapeutics, 7th edn. Macmillan, New York, pp 491–531
10.
go back to reference Bronaut G, Pouzeratte Y, Mann C et al (2003) Posterior perineal block with ropivacaine 0.75 % for pain control during and after hemorrhoidectomy. Reg Anesth Pain Med 28:228–232 Bronaut G, Pouzeratte Y, Mann C et al (2003) Posterior perineal block with ropivacaine 0.75 % for pain control during and after hemorrhoidectomy. Reg Anesth Pain Med 28:228–232
11.
go back to reference Karanlike H, Akturk R, Camlica H et al (2009) The effect of glyceryl trinitrate ointment on posthemorrhoidectomy pain and wound healing: results of a randomized, double-blind placebo-controlled study. Dis Colon Rectum 52:280–285CrossRef Karanlike H, Akturk R, Camlica H et al (2009) The effect of glyceryl trinitrate ointment on posthemorrhoidectomy pain and wound healing: results of a randomized, double-blind placebo-controlled study. Dis Colon Rectum 52:280–285CrossRef
12.
go back to reference Silverman R, Bendick PJ, Wasvary H (2005) A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy. Dis Colon Rectum 48:1913–1916PubMedCrossRef Silverman R, Bendick PJ, Wasvary H (2005) A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy. Dis Colon Rectum 48:1913–1916PubMedCrossRef
13.
go back to reference Davies J, Duffy D, Boyt N et al (2003) Botulinum toxin (Botox) reduces pain after hemorrhoidectomy. Dis Colon Rectum 46:1097–1102PubMedCrossRef Davies J, Duffy D, Boyt N et al (2003) Botulinum toxin (Botox) reduces pain after hemorrhoidectomy. Dis Colon Rectum 46:1097–1102PubMedCrossRef
14.
go back to reference Nicholson T, Armstrong D (2004) Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing. Dis Colon Rectum 47:711–716PubMedCrossRef Nicholson T, Armstrong D (2004) Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing. Dis Colon Rectum 47:711–716PubMedCrossRef
15.
go back to reference Ala S, Saeedi M, Eshghi F et al (2008) Topical metronidazole can reduce pain after surgery and pain on defecation in postoperative hemorrhoidectomy. Dis Colon Rectum 51:235–238PubMedCrossRef Ala S, Saeedi M, Eshghi F et al (2008) Topical metronidazole can reduce pain after surgery and pain on defecation in postoperative hemorrhoidectomy. Dis Colon Rectum 51:235–238PubMedCrossRef
16.
go back to reference Anonymous (2006) Martindale: the complete drug reference, 35th edn. Pharmaceutical Press, London, p 1596 Anonymous (2006) Martindale: the complete drug reference, 35th edn. Pharmaceutical Press, London, p 1596
17.
go back to reference Foye WO (2007) Foye’s principles of medicinal chemistry, 6th edn. Philadelphia, Williams & Wilkins, p 1024 Foye WO (2007) Foye’s principles of medicinal chemistry, 6th edn. Philadelphia, Williams & Wilkins, p 1024
18.
go back to reference Szabo S, Hollander D (1989) Pathways of gastrointestinal protection and repair: mechanisms of action of sucralfate. Am J Med 86(Suppl 6A):23–31PubMedCrossRef Szabo S, Hollander D (1989) Pathways of gastrointestinal protection and repair: mechanisms of action of sucralfate. Am J Med 86(Suppl 6A):23–31PubMedCrossRef
19.
go back to reference Rees WDW (1991) Mechanisms of gastroduodenal protection by sucralfate. Am J Med 91(Suppl 2A):58S–63SPubMedCrossRef Rees WDW (1991) Mechanisms of gastroduodenal protection by sucralfate. Am J Med 91(Suppl 2A):58S–63SPubMedCrossRef
20.
go back to reference Folkman J, Szabo S, Shing Y (1990) Sucralfate affinity for fibroblast growth factor. J Cell Biol 111:223A Folkman J, Szabo S, Shing Y (1990) Sucralfate affinity for fibroblast growth factor. J Cell Biol 111:223A
21.
go back to reference Szabo S, Vattay P, Scarbrough E et al (1991) Role of vascular factors, including angiogenesis, in the mechanisms of action of sucralfate. Am J Med 91(Suppl 2A):158S–160SPubMedCrossRef Szabo S, Vattay P, Scarbrough E et al (1991) Role of vascular factors, including angiogenesis, in the mechanisms of action of sucralfate. Am J Med 91(Suppl 2A):158S–160SPubMedCrossRef
22.
go back to reference Hayashi AH, Lau HYC, Gillis DA (1991) Topical sucralfate: effective therapy for the management of resistant peristomal and perineal excoriation. J Pediatr Surg 26:1279–1281PubMedCrossRef Hayashi AH, Lau HYC, Gillis DA (1991) Topical sucralfate: effective therapy for the management of resistant peristomal and perineal excoriation. J Pediatr Surg 26:1279–1281PubMedCrossRef
23.
go back to reference Tryba M, Mantey-Stiers F (1987) Antibacterial activity of sucralfate in human gastric juice. Am J Med 83:125–127PubMedCrossRef Tryba M, Mantey-Stiers F (1987) Antibacterial activity of sucralfate in human gastric juice. Am J Med 83:125–127PubMedCrossRef
24.
go back to reference Delavarian Z, Orafai H, Molashahi L et al (2007) The effect of topical sucralfate suspension on oral aphthae. J Dentistry 4:72–77 Delavarian Z, Orafai H, Molashahi L et al (2007) The effect of topical sucralfate suspension on oral aphthae. J Dentistry 4:72–77
25.
go back to reference Alpsoy E, Durusoy C, Yilmaz E (1999) The use of sucralfate suspension in the treatment of oral and genital ulceration of Behçet disease. Arch Dermatol 135:529–532PubMedCrossRef Alpsoy E, Durusoy C, Yilmaz E (1999) The use of sucralfate suspension in the treatment of oral and genital ulceration of Behçet disease. Arch Dermatol 135:529–532PubMedCrossRef
26.
go back to reference Freeman SB, Markwell JK (1992) Sucralfate in alleviating post-tonsillectomy pain. Laryngoscope 102:1242–1246PubMedCrossRef Freeman SB, Markwell JK (1992) Sucralfate in alleviating post-tonsillectomy pain. Laryngoscope 102:1242–1246PubMedCrossRef
27.
go back to reference Özcan M, Altuntaç A, Ünal A et al (1998) Sucralfate for post-tonsillectomy analgesia. Otolaryngology 119:700–704 Özcan M, Altuntaç A, Ünal A et al (1998) Sucralfate for post-tonsillectomy analgesia. Otolaryngology 119:700–704
28.
go back to reference Sampaio ALL, Pinheiro TG, Furtado PL et al (2007) Evaluation of early postoperative morbidity in pediatric tonsillectomy with the use of sucralfate. Int J Pediatr Otorhinolaryngol 71:645–651PubMedCrossRef Sampaio ALL, Pinheiro TG, Furtado PL et al (2007) Evaluation of early postoperative morbidity in pediatric tonsillectomy with the use of sucralfate. Int J Pediatr Otorhinolaryngol 71:645–651PubMedCrossRef
29.
go back to reference Miura MS, Saleh C, De Andrade M et al (2009) Topical sucralfate in post-adenotonsillectomy analgesia in children: a double-blind randomized clinical trial. Otolaryngol Head Neck 141:322–328CrossRef Miura MS, Saleh C, De Andrade M et al (2009) Topical sucralfate in post-adenotonsillectomy analgesia in children: a double-blind randomized clinical trial. Otolaryngol Head Neck 141:322–328CrossRef
30.
go back to reference Kyrmizakis DE, Papadakis CE, Bizakis JG et al (2001) Sucralfate alleviating post-laser-assisted uvulopalatoplasty pain. Am J Otolaryngol 22:55–58PubMedCrossRef Kyrmizakis DE, Papadakis CE, Bizakis JG et al (2001) Sucralfate alleviating post-laser-assisted uvulopalatoplasty pain. Am J Otolaryngol 22:55–58PubMedCrossRef
31.
go back to reference Zodpe P, Cho JG, Kang HJ et al (2006) Efficacy of sucralfate in the postoperative management of uvulopalatopharyngoplasty. Arch Otolaryngol 132:1082–1085CrossRef Zodpe P, Cho JG, Kang HJ et al (2006) Efficacy of sucralfate in the postoperative management of uvulopalatopharyngoplasty. Arch Otolaryngol 132:1082–1085CrossRef
32.
go back to reference Guo CS, Chuang V, Chien CY (2012) Topical sucralfate for pain after oral CO2 laser surgery: a prospective, randomized, controlled trial. Am J Otolaryngol 33:109–112PubMedCrossRef Guo CS, Chuang V, Chien CY (2012) Topical sucralfate for pain after oral CO2 laser surgery: a prospective, randomized, controlled trial. Am J Otolaryngol 33:109–112PubMedCrossRef
33.
go back to reference Makkonen TA, Boström P, Vilja P et al (1994) Sucralfate mouth washing in the prevention of radiation-induced mucositis: a placebo-controlled double-blind randomized study. Int J Radiat Oncol 30:177–182CrossRef Makkonen TA, Boström P, Vilja P et al (1994) Sucralfate mouth washing in the prevention of radiation-induced mucositis: a placebo-controlled double-blind randomized study. Int J Radiat Oncol 30:177–182CrossRef
34.
go back to reference Etiz D, Erkal HSE, Serin M et al (2000) Clinical and histopathological evaluation of sucralfate in prevention of oral mucositis induced by radiation therapy in patients with head and neck malignancies. Oral Oncol 36:116–120PubMedCrossRef Etiz D, Erkal HSE, Serin M et al (2000) Clinical and histopathological evaluation of sucralfate in prevention of oral mucositis induced by radiation therapy in patients with head and neck malignancies. Oral Oncol 36:116–120PubMedCrossRef
35.
go back to reference Saarilahti K, Kajanti M, Joensuu T et al (2002) Comparison of granulocyte-macrophage colony-stimulating factor and sucralfate mouthwashes in the prevention of radiation-induced mucositis: a double-blind prospective randomized phase III study. Int J Radiat Oncol 54:479–485CrossRef Saarilahti K, Kajanti M, Joensuu T et al (2002) Comparison of granulocyte-macrophage colony-stimulating factor and sucralfate mouthwashes in the prevention of radiation-induced mucositis: a double-blind prospective randomized phase III study. Int J Radiat Oncol 54:479–485CrossRef
36.
go back to reference Kochhar R, Sriram PVJ, Sharma SC et al (1999) Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension. Dig Dis Sci 44:973–978PubMedCrossRef Kochhar R, Sriram PVJ, Sharma SC et al (1999) Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension. Dig Dis Sci 44:973–978PubMedCrossRef
37.
go back to reference Wells M, Macmillan M, Raab G et al (2004) Does aqueous or sucralfate cream affect the severity of erythematous radiation skin reactions? A randomised controlled trial. Radiother Oncol 73:153–162PubMedCrossRef Wells M, Macmillan M, Raab G et al (2004) Does aqueous or sucralfate cream affect the severity of erythematous radiation skin reactions? A randomised controlled trial. Radiother Oncol 73:153–162PubMedCrossRef
38.
go back to reference Banati A, Chowdhury SR, Mazumder S (2001) Topical use of sucralfate cream in second and third degree burns. Burns 27:465–469PubMedCrossRef Banati A, Chowdhury SR, Mazumder S (2001) Topical use of sucralfate cream in second and third degree burns. Burns 27:465–469PubMedCrossRef
39.
go back to reference Mantoo S, Raina VK (1997) Topical sucralfate: role in the prevention and healing of skin excoriations around enterostomas, gastro-intestinal fistulas and perineal region. J Indian Assoc Pediatr Surg 2:126–129 Mantoo S, Raina VK (1997) Topical sucralfate: role in the prevention and healing of skin excoriations around enterostomas, gastro-intestinal fistulas and perineal region. J Indian Assoc Pediatr Surg 2:126–129
40.
go back to reference Da Fonseca LM, De Lemos SouzaF, Arantes V et al (2010) Giant refractory solitary rectal ulcer syndrome treated with topical sucralfate. Int J Colorectal Dis 25:1025–1026PubMedCrossRef Da Fonseca LM, De Lemos SouzaF, Arantes V et al (2010) Giant refractory solitary rectal ulcer syndrome treated with topical sucralfate. Int J Colorectal Dis 25:1025–1026PubMedCrossRef
41.
go back to reference Gupta PJ, Heda PS, Shrirao SA et al (2011) Topical sucralfate treatment of anal fistulotomy wounds: a randomized placebo-controlled trial. Dis Colon Rectum 54:699–704PubMedCrossRef Gupta PJ, Heda PS, Shrirao SA et al (2011) Topical sucralfate treatment of anal fistulotomy wounds: a randomized placebo-controlled trial. Dis Colon Rectum 54:699–704PubMedCrossRef
42.
go back to reference Gupta PG, Heda PS, Kalaskar S et al (2008) Topical sucralfate decreases pain after hemorrhoidectomy and improves healing. Dis Colon Rectum 51:231–234PubMedCrossRef Gupta PG, Heda PS, Kalaskar S et al (2008) Topical sucralfate decreases pain after hemorrhoidectomy and improves healing. Dis Colon Rectum 51:231–234PubMedCrossRef
43.
go back to reference Anonymous (2008) The United States Pharmacopeia, 31st edn. Baltimore, Port City Press, pp 71–80/3279–3281 Anonymous (2008) The United States Pharmacopeia, 31st edn. Baltimore, Port City Press, pp 71–80/3279–3281
44.
go back to reference Milligan ET, Morgan CN, Jones LE et al (1937) Surgical anatomy of the anal canal and the operative treatment of haemorrhoids. Lancet 2:1119–1124CrossRef Milligan ET, Morgan CN, Jones LE et al (1937) Surgical anatomy of the anal canal and the operative treatment of haemorrhoids. Lancet 2:1119–1124CrossRef
Metadata
Title
Efficacy of 10 % Sucralfate Ointment in the Reduction of Acute Postoperative Pain After Open Hemorrhoidectomy: A Prospective, Double-Blind, Randomized, Placebo-Controlled Trial
Authors
Shahram Ala
Majid Saeedi
Fariborz Eshghi
Mohamadreza Rafati
Vahid Hejazi
Roja Hadianamrei
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 1/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-012-1805-8

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