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Perioperative local anaesthesia for reducing pain following tonsillectomyHollis LJ, Burton MJ, Millar JM
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SummaryLocal anaesthetics applied during removal of the tonsils may not reduce pain following the operationRemoval of the tonsils is one of the most common operations and adequate pain control following surgery is an important aspect of patient care. Some surgeons apply local anaesthetics (in addition to the general anaesthetic) to the area around the tonsils before, during, or after the operation in an attempt to improve pain control. The review found that this practice may not reduce pain following the operation. However, the studies included in the review had various shortcomings and further studies will be needed to allow any firm conclusions.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 25. 1999 AbstractBackgroundPain relief after tonsillectomy is an important part of post-operative management. Sometimes local anaesthetics are administed to the tonsillar region, but their effectiveness in relieving pain has not been formally assessed. ObjectivesTo assess the effects of pre- and post-operative local anaesthesia for pain reduction following tonsillectomy. Search strategyCochrane Controlled Trials Register, Medline, Embase and the Oxford Pain Database. Reference lists from identified publications, including those in non-English language publications, were scanned. Date of the most recent search was September 1998. Selection criteriaRandomised controlled trials of adults and/or children undergoing tonsillectomy alone with local anaesthetic Data collection and analysisAll three reviewers extracted data independently and assessed trials for quality. Four authors were contacted to obtain information on either the method of randomisation or the type of intervention used. Main resultsThirty trials were initially identified but only six trials met the inclusion criteria. These were all published in the English language literature between 1989 and 1997. Trials were excluded because procedures in addition to tonsillectomy were undertaken, inadequate randomisation techniques were used or because group sizes were inadequate. Of the six included studies, five involved local anaesthetic injection and one application of local anaesthetic spray. These studies used validated pain scores and measurement of supplemental analgesic intake for assessment of pain. However, some studies also included inappropriate, possibly post-hoc, outcome measures such as 'global pain scores' which may have resulted in bias. No included study showed a significant difference between intervention and control, other than for outcome measures which were felt to be inappropriate, such as the one mentioned above. Authors' conclusionsThere is no evidence that the use of perioperative local anaesthetic in patients undergoing tonsillectomy improves post-operative pain control. The trials identified were of small size and several involved the perioperative co-administration of intravenous opiates which may have masked any beneficial effect of the local anaesthetic. Further randomised controlled trials are necessary. |