Sucralfate for Posttonsillectomy Analgesia

Abstract

Pain is one of the most troublesome complications of tonsillectomy. The pain appears as throat pain, otalgia, or both, and continues until mucosal recovery on the tonsillar fossae is complete. Some surgical and hemostasis techniques may increase pain. Analgesics, antibiotics, steroids, and local and topical anesthetics are used to relieve posttonsillectomy pain, but none has the desired effectiveness. The pain reliever must not increase bleeding and must have minimal side effects. Sucralfate, a basic amino salt of sucrose octasulfate, binds to the matrix protein of a peptic ulcer and produces a protective barrier. Tonsillectomy leaves two large ulcerous wounds, and sucralfate may bind those wounds as it does peptic ulcers. In this controlled study, the efficacy of sucralfate on posttonsillectomy throat pain, otalgia, analgesic requirement, degree of strength, bleeding, body temperature, and mucosal recovery is investigated in 80 patients. Sucralfate is found to significantly reduce throat pain and analgesic requirement after surgery.

Evaluation of early postoperative morbidity in pediatric tonsillectomy with the use of sucralfate

“…In other studies, this agent was not found to promote postoperative pain relief [3]. Benzocaine also did not reduce posttonsillectomy pain [1]. Benzydamine hydrochloride spray, a local anti-inflammatory and analgesic agent, was used to control posttonsillectomy pain.…”

“…The negatively charged polyanions of sucralfate form polyvalent bonds with the positively charged mucoproteins of the damaged mucosa, so the drug adheres to the mucoproteins at the ulcer site, forming a protective coating against gastric acid, pepsin, and bile salts [14]. It is claimed to have a cytoprotective effect and to increase mucosal renewal by stimulating prostaglandin E synthesis [1]. Thus, the result is the promotion of the healing process in the mucosal surface [21].…”

“…Tonsillectomy is among the most frequent otorhinolaryngologic surgeries, especially in the pediatric age group [1]. It was first described in India in 1000 BC.…”

“…Pain following tonsillectomy is due to the inflammation and irritation of nerve endings and pharyngeal muscle spasm [1]. This process does not completely subside until the muscle becomes totally covered by the mucosa 14-20 days after surgery.…”

“…It also inhibits pepsin, and shows a cytoprotective effect, and forms a viscous adhesive barrier on the surface of the intact mucosa of the intestine and stomach [1,13,14]. If we consider the wounds of tonsillectomy to be two large ulcers, sucralfate might act in the same manner, protecting the raw surfaces of the superior constrictor and preventing muscle spasm and the irritation of open nerve endings, thus promoting healing and reducing pain. There are few studies in the literature dealing with the use of sucralfate and postoperative tonsillectomy morbidity [1,[13][14][15]. To our knowledge, only Esteban et al [15] studied the effects of sucralfate in alleviating postoperative pain in children.…”