Nonpharmacologic Therapy for Pediatric Posttonsillectomy Pain: A Systematic Review

To understand efficacies of nonpharmacologic therapy for pediatric posttonsillectomy pain.

CINAHL, Cochrane Library, PubMed, and Scopus.

Studies on nonpharmacologic interventions for pediatric posttonsillectomy pain were included in this systematic review. Extracted variables included demographics, pain scores, and postoperative bleeding. Pain scores on 0-10 scales (eg, Visual Analog Scale, Wong-Baker, FLACC, Oucher) were analyzed, and scales using different ranges, but comparable pain markers, were standardized to 0 to 10. Data were summarized as means, proportions (%), and differences (Δ) with 95% confidence intervals (CI). Risk of bias was evaluated using the Joanna Briggs Institute (JBI), ROBINS-I, or ROB-2 tools.

Twenty-three studies (n = 3538) met inclusion criteria. Several nonpharmacologic intervention groups showed significant reductions in postoperative pain compared to control. At 6 hours postoperatively, acupuncture (∆ -0.8, 95% CI [-1.17, -0.43], P < .01), ice cream (∆ -1.4, 95% CI [-2.28, -0.52], P < .01), cartoon distraction (∆ -1.3, 95% CI [-1.83, -0.77], P < .01), and lavender essence inhalation (∆ -0.9, 95% CI [-1.76, -0.04], P = .04), were associated with lower pain scores. By postoperative Day 7 sugar-free gum was the only intervention associated with lower pain scores (∆ -2.2, 95% CI [-3.07, -1.33], P < .01). Salvia officinalis, cold diet, and food and effort restrictions were associated with less postoperative bleeding. Honey, intraoperative music, autologous serum, and liquid/soft diet (among other interventions) showed no changes in postoperative pain.

Nonpharmacologic interventions including acupuncture, sugar-free gum, distraction, and select oil essence therapies are associated with less pain, with some interventions reducing postoperative bleeding risk. This supports incorporating non-pharmacologic adjuncts for pediatric posttonsillectomy pain, though further high-quality studies are needed.