Tonsillectomy is one of the most frequently performed
surgical procedures; however,
pain management remains challenging. Procedure-specific efficacy as well as specific risks of treatment options should guide selection of
pain management protocols based on evidence and should optimise
analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal
pain management after
tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta-analysis guidelines with procedure-specific
postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing
postoperative pain using
analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre-operative and intra-operative interventions that improved
postoperative pain were
paracetamol; non-steroidal anti-inflammatory drugs; intravenous
dexamethasone;
ketamine (only assessed in children); gabapentinoids;
dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration;
antibiotics; and
magnesium sulphate. Limited evidence was found for
clonidine. The
analgesic regimen for
tonsillectomy should include
paracetamol; non-steroidal anti-inflammatory drugs; and intravenous
dexamethasone, with
opioids as rescue
analgesics.
Analgesic adjuncts such as intra-operative and postoperative acupuncture as well as postoperative honey are also recommended.
Ketamine (only for children);
dexmedetomidine; or gabapentinoids may be considered when some of the first-line
analgesics are contra-indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for
postoperative pain relief after
tonsillectomy.