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Local anaesthetic for post‐tonsillectomy pain: a systematic review and meta‐analysis
Author(s) -
Grainger J.,
Saravanappa N.
Publication year - 2008
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/j.1749-4486.2008.01815.x
Subject(s) - medicine , tonsillectomy , local anaesthetic , meta analysis , anesthesia , adverse effect , analgesic , placebo , randomized controlled trial , systematic review , visual analogue scale , medline , otorhinolaryngology , general anaesthetic , surgery , general anaesthesia , alternative medicine , pathology , political science , law
Background: Tonsillectomy is one of the most commonly performed procedures in otolaryngology. Pain is a significant aspect of post‐operative patient morbidity. The use of local anaesthetic, by infiltration or topical application, has been advocated as a way of reducing post‐operative pain. Objectives: To review the current evidence for the use of local anaesthetic as a means of reducing post‐tonsillectomy pain and reducing supplemental analgesic requirements. Type of review: A systematic review of the literature pertaining to the use of local anaesthetic agents for post‐tonsillectomy pain and meta‐analysis of randomised control trials assessing pain scores. Search strategy: Systematic literature searches of MEDLINE (1952–2008), EMBASE (1974–2008) and the Cochrane Central Register of Controlled Trials. Evaluation method: Review of all randomised controlled trials by two authors and grading of articles for quality. Results: Thirteen studies were included. Overall, local anaesthetic, applied topically or infiltrated, significantly reduces pain scores compared with controls at 4–6 h, −0.66 (95% CI: −0.82, −0.50); 20–24 h, −0.34 (95% CI: −0.51, −0.18) and on day 5, −0.97 (95% CI: −1.30, −0.63) (standardised mean differences). These changes approximate to a reduction in pain of between 7 and 19 mm on a 0–100 mm visual analogue scale. Most studies did not report a difference in supplemental analgesia or in adverse events. Conclusion: Local anaesthetic does seem to provide a modest reduction in post‐tonsillectomy pain. Topical local anaesthetic on swabs appears to provide a similar level of analgesia to that of infiltration without the potential adverse effects and should be the method of choice for providing additional post‐operative analgesia.