#10‐Year Challenge

Abstract

IntroductionAdequate management of post‐tonsillectomy pain is an important consideration in postoperative management after tonsillectomy. A 2008 meta‐analysis showed that the use of local anaesthetic either by infiltration or topical application reduced postoperative pain.ObjectivesTo review the current evidence for the use of local anaesthetic as a means of reducing post‐tonsillectomy pain and compare current evidence to the previous meta‐analysis 10 years ago.MethodSystematic literature searches of MEDLINE [*"ANESTHETICS, LOCAL"/ AND *TONSILLECTOMY/], EMBASE [*"LOCAL ANESTHETIC AGENT"/ AND *TONSILLECTOMY/] and PubMed [(Tonsillectomy).ti,ab AND (Local Anaesthetic).ti,ab OR (Local Anesthetic).ti,ab]. A meta‐analysis of randomised control trials assessing the use of local anaesthetic agents for post‐tonsillectomy pain.ResultsTwenty‐three studies were included in the meta‐analysis. Overall, local anaesthetic, applied topically or infiltrated, significantly reduces pain scores compared with controls at 4‐6 hours [−0.65 (95% CI: −0.77; −0.53)]; 24 hours [−0.50 (95% CI: −0.66, −0.35)]; and 5‐7 days [−0.78 (95% CI: −0.90, −0.65)] (standardised mean differences).ConclusionCurrent studies suggest that use of peri‐operative local anaesthetic during tonsillectomy does improve postoperative pain outcomes. The limitations of the analysis are as follows: all studies are small, and a multi‐centred larger trial is recommended to guarantee statistical reliability. There was no description of significant adverse side effects from local anaesthetic use.