The Effects of Pain Controlling Agents on Paediatric Tonsillectomy: A Systematic Review and Network Meta-Analysis

To evaluate the effects and morbidities associated with perioperatively administered analgesics in paediatric patients undergoing tonsillectomy.

Systematic review and network meta-analysis (NMA) of randomised controlled trials.

Paediatric patients undergoing tonsillectomy.

The treatment networks included five interventions (paracetamol, paracetamol with opioids, ibuprofen, ketorolac or opioids) and a control group (placebo or saline). The outcomes measured were the incidence of postoperative bleeding (any event and those requiring surgical intervention), postoperative nausea and vomiting (PONV) and the frequency of analgesic intake. Both pairwise analysis and NMA were utilised to assess the data.

No treatments induced significant postoperative bleeding compared with the control. Paracetamol, ibuprofen and ketorolac tended to decrease the incidence of PONV. Only ibuprofen significantly reduced the need for analgesics (odds ratio = 0.32, 95% confidence interval = 0.11-0.91, p < 0.05). All other comparisons showed trends but lacked statistical significance, as their confidence intervals included 1.0. The ranking hierarchy revealed that ketorolac ranked the lowest in postoperative bleeding but first in the incidence of PONV. Paracetamol ranked second in postoperative bleeding, PONV, and need for analgesics.

While ibuprofen appeared to be the most effective in managing postoperative pain, paracetamol showed favourable trends in reducing postoperative bleeding, PONV, and the need for additional analgesics. Ketorolac tended to be associated with a lower incidence of PONV but showed a tendency toward a higher incidence of postoperative bleeding. However, further well-designed, standardised studies would be needed to confirm these conclusions.