Intraoperative Local Anesthesia for Reducing Pain following Tonsillectomy

Abstract

Objectives:

Perform a Cochrane review to systematically appraise the available evidence of pain relief through the use of intra-operative local anaesthetic (LA) administration to the tonsillar region in adults and children undergoing tonsillectomy.

Methods:

The study followed the rigorous systematic review and meta-analysis methodology as developed by the Cochrane Collaboration. A comprehensive search strategy was applied to multiple databases for published and unpublished trials up to April 2012. Randomized, double-blind, placebo-controlled trials were eligible. Two reviewers independently extracted data and assessed trials for quality. Data analyses were performed using the RevMan 5.1 software.

Results:

Sixty-six randomized controlled trials were included in the review. Eleven trials assessing peritonsillar infiltration of LA and seven trials that investigated topical application of LA were suitable for meta-analysis. Peritonsillar LA infiltration was associated with significant reduction in pain up to 2 hours after surgery (mean difference -1.34 on a scale of -10 to 10; 95% CI -1.80 to -0.88; P< 0.00001). Topical LA application to the tonsillar fossa was also associated with significant pain reduction in the early post-operative period (mean difference -0.66 on a scale of -1 to 1; 95% CI -1.06 to -0.27; P = 0.001). Intra-operative LA was associated with a longer period of time without analgesic requests post-operatively (mean difference 12 minutes; 95% CI 2.0 to 21.8; P = 0.020).

Conclusions:

Based on the available evidence, we would advocate routine intra-operative application of LA, whether infiltrative or topical, for patients undergoing tonsillectomy.