Efficacy and Safety of Topical Sucralfate for Post-Tonsillectomy Pain in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Importance: Post-tonsillectomy pain remains difficult to manage in children despite standard analgesia. Topical sucralfate may reduce pain by coating the tonsillar bed and promoting mucosal recovery. Objective: To evaluate the efficacy and safety of topical sucralfate in reducing post-tonsillectomy pain and accelerating recovery in children. Design: Systematic review and meta-analysis of randomized controlled trials. Setting: PubMed, Web of Science, Cochrane Library, and Google Scholar were searched until July 2025. Participants: Children aged ≤18 undergoing tonsillectomy. Interventions: Topical sucralfate applied to the tonsillar bed intraoperatively or given postoperatively as an oral rinse. Main Outcomes and Measures: The overall effect size for the primary outcome (postoperative pain during the first postoperative week) was presented as standardized mean differences (SMDs), while secondary outcomes (analgesic use, return to oral intake, and adverse events) were reported as descriptive comparisons across trials. Results: Six randomized trials involving 485 children aged 3 to 12 years were included. Topical sucralfate reduced postoperative pain, with the greatest benefit observed from postoperative day 2 onward compared with placebo. On postoperative day 1, sucralfate lowered pain scores (5 trials; n = 432; SMD, −1.01; 95% confidence interval, −1.45 to −0.57; P < .00001). Sucralfate reduced systemic analgesic use and supported an earlier return to oral intake. Adverse events, including bleeding, nausea, and vomiting, occurred at similar rates in both groups. Conclusions: Topical sucralfate is a safe and effective adjunct after pediatric tonsillectomy. It reduces early postoperative pain and improves functional recovery. Relevance: These findings support topical sucralfate as a simple, low-cost option for postoperative analgesia in children. Larger trials are needed to confirm these benefits.