AI Article Synopsis

  • Effective pain management post-tonsillectomy in children is crucial, and this study aimed to determine the best analgesics for such procedures.
  • The research involved a systematic review and meta-analysis of 82 studies, examining various analgesic methods and their impact on pain relief and complications in over 6,100 pediatric patients.
  • Key findings showed that local anesthetics, opioids (like morphine), and glucocorticoids (such as dexamethasone) were effective in reducing pain, while dexamethasone also decreased postoperative complications compared to other methods.

Article Abstract

Background: Timely and effective analgesia after tonsillectomy in children is crucial, but there is currently no consensus on the optimal analgesics. This analysis aimed to identify the most effective for this surgery.

Methods: We conducted a systematic review and network meta-analysis (random-effects model) of randomized controlled trials comparing analgesics for pediatric tonsillectomy. We searched relevant studies in PubMed, Embase, Cochrane Library, and Web of Science databases from database inception until June 30, 2023. Children (≤18 years old) who underwent tonsillectomy with or without adenoidectomy were eligible for inclusion. Primary outcomes encompassed pain score and postoperative complications; secondary outcomes included postoperative supplementary analgesia, functional evaluation, and sedation score.

Results: In total 82 randomized controlled trials involving 6110 patients were included, forming the primary network that comprised comparative data for 16 different interventions (including placebo) across 6 types of analgesics. The integrated analysis revealed that nonsteroidal anti-inflammatory drugs except ketoprofen had no significant effects in relieving postoperative pain (mean difference [MD], -2.96; 95% confidence interval [CI], -5.59 to -0.32; P = .10). Local anesthetic infiltration (bupivacaine: MD, -2.76; 95% CI, -3.88 to -1.64, P = .01; ropivacaine: MD, -2.49; 95% CI, -4.25 to -0.73, P = .02; lidocaine: MD, -1.86; 95% CI,-3.52 to -0.2, P = .02; levobupivacaine: MD, -1.06; 95% CI, -2.00 to -0.12, P = .01), analgesics (morphine: MD, -2.07; 95% CI, -3.14 to -1.00; P = .02), and glucocorticoids (dexamethasone: MD, -0.45; 95% CI, -0.73 to -0.16; P = .01) were effective in relieving pain after pediatric tonsillectomy. In reducing incidence of postoperative complications, dexamethasone was superior to bupivacaine (relative risk [RR], 0.60; 95% CI, 0.43-0.83; P = .02). Regarding the number of patients needing rescue analgesic, levobupivacaine was superior to lidocaine (RR, 0.51; 95% CI, 0.32-0.81; P = .01). In rescue analgesia requirement, morphine outperformed lidocaine (RR, 0.44; 95% CI, 0.25-0.75; P = .01) and ropivacaine (RR, 0.54; 95% CI, 0.32-0.91; P = .01) in efficacy but not different from bupivacaine (P = .10) and levobupivacaine (P = .12).

Conclusions: Based on these results, we would recommend local bupivacaine infiltration or local levobupivacaine infiltration for older children and dexamethasone injection for younger children for early analgesia after tonsillectomy. However, clinicians should choose the optimal analgesic based on the individual child's condition and clinical situation.

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Source
http://dx.doi.org/10.1213/ANE.0000000000007352DOI Listing

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