Local anaesthetic for post-tonsillectomy pain: a systematic review and meta-analysis

Tonsillectomy is one of the most commonly performed procedures in otolaryngology. Pain is a significant aspect of post-operative patient morbidity. The use of local anaesthetic, by infiltration or topical application, has been advocated as a way of reducing post-operative pain.

To review the current evidence for the use of local anaesthetic as a means of reducing post-tonsillectomy pain and reducing supplemental analgesic requirements.

A systematic review of the literature pertaining to the use of local anaesthetic agents for post-tonsillectomy pain and meta-analysis of randomised control trials assessing pain scores.

Systematic literature searches of MEDLINE (1952-2008), EMBASE (1974-2008) and the Cochrane Central Register of Controlled Trials.

Review of all randomised controlled trials by two authors and grading of articles for quality.

Thirteen studies were included. Overall, local anaesthetic, applied topically or infiltrated, significantly reduces pain scores compared with controls at 4-6 h, -0.66 (95% CI: -0.82, -0.50); 20-24 h, -0.34 (95% CI: -0.51, -0.18) and on day 5, -0.97 (95% CI: -1.30, -0.63) (standardised mean differences). These changes approximate to a reduction in pain of between 7 and 19 mm on a 0-100 mm visual analogue scale. Most studies did not report a difference in supplemental analgesia or in adverse events.

Local anaesthetic does seem to provide a modest reduction in post-tonsillectomy pain. Topical local anaesthetic on swabs appears to provide a similar level of analgesia to that of infiltration without the potential adverse effects and should be the method of choice for providing additional post-operative analgesia.