Complementary medicine for post-tonsillectomy pain management in children: a network meta-analysis

Managing postoperative pain following tonsillectomy presents a significant challenge and often remains suboptimal. This study aimed to compare and rank complementary interventions for alleviating tonsillectomy-related pain in children.

A comprehensive search was conducted in the databases, including PubMed, Web of Science, Scopus, ClinicalTrials.gov, CENTRAL, and Google Scholar, to identify eligible randomized controlled trials. The quality of the included studies was evaluated using the ROB-2 tool. Data analysis was performed using a random-effects model with STATA version 17 software. Consistency within the network and loops was assessed, and interventions were ranked using the Surface Under the Cumulative Ranking (SUCRA) method.

A total of 19 studies were included following the PRISMA guidelines. The findings revealed that complementary medicine significantly reduced post-tonsillectomy pain in the intervention group compared to the control group (SMD: -0.97, 95% CI: -1.35 to -0.59, Z = 5.01, P < 0.001, I ² = 91.9%). Among the interventions evaluated, imagery (mean rank: 1.9; SUCRA: 0.9) and acupuncture (mean rank: 2.0; SUCRA: 0.9) demonstrated the highest effectiveness in alleviating post-tonsillectomy pain. Conversely, restriction interventions were identified as the least effective (mean rank: 10.7; SUCRA: 0.1).

The results found the potential benefits of integrating effective complementary interventions alongside routine treatment to reduce post-tonsillectomy pain in children. However, the limited availability of well-designed clinical trials directly comparing these complementary interventions highlights the need for further rigorous and high-quality research.