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Meta-Analysis
. 2025 Jan 9;15(1):1476.
doi: 10.1038/s41598-024-85008-5.

Systematic review and meta-analysis of pain management after tonsillectomy

Katharina Geißler  1 , Daniel Scham  2 , Winfried Meißner  3 , Peter Schlattmann  4 , Orlando Guntinas-Lichius  2
Affiliations
Meta-Analysis

Systematic review and meta-analysis of pain management after tonsillectomy

Katharina Geißler et al. Sci Rep. .

Abstract

Tonsillectomy is one of the most common operations. Tonsillectomy is also one of the most painful surgical procedures. However, there is still no satisfactory standard for postoperative pain management. Four databases (Cochrane Library, Ovid Technologies, PubMed, Web of Science) were searched for the period from 1908 to 2019. The systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were pooled using random-effects and fixed-effects models. Randomized controlled trials, reviews and meta-analyses were included. Primary outcomes were quantitative pain intensity in the first 24 h after tonsillectomy and on days 1, 3, and 7 postoperatively. The search yielded 1594 publications, of which 111 publications with 7566 patients, both children and adults, could be included. Intraoperative medication with intravenous dexamethasone significantly reduced pain (mean difference [MD] -0.42; 95% confidence interval [CI]: -0.61- -0.24). Among the local anesthetics, only the preoperative injection of levobupivacaine into the tonsillar compartment was able to provide sufficient pain reduction up to three days after tonsillectomy (MD: -1.92; 95% CI: -2.73 - -1.11). Preoperative or intraoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs) significantly reduced pain (MD: -0.75; 95% CI: -0.87- -0.63). Steroids and NSAIDs are an important part of pain management after tonsillectomy.

Keywords: Clinical trial; Meta-analysis; NSAID; Pain therapy; Tonsillectomy.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart.
Fig. 2
Fig. 2
Forest plot for meta-analysis related to the outcome measure postoperative nausea and vomiting for the use of non-steroidal anti-inflammatory drugs.
Fig. 3
Fig. 3
Forest plot for meta-analysis related to the outcome measure primary postoperative bleeding for the use of non-steroidal anti-inflammatory drugs.
Fig. 4
Fig. 4
Forest plot for meta-analysis related to the outcome secondary postoperative bleeding for the use of non-steroidal anti-inflammatory drugs.
Fig. 5
Fig. 5
Forest plot for meta-analysis of pain measurement within the first 24 h for the use of non-steroidal anti-inflammatory drugs.
Fig. 6
Fig. 6
Forest plot for meta-analysis of pain measurement on first postoperative day for the use of non-steroidal anti-inflammatory drugs.
Fig. 7
Fig. 7
Forest plot for the meta-analysis of pain measurement on the third postoperative day for the use of non-steroidal anti-inflammatory drugs.
Fig. 8
Fig. 8
Forest plot for meta-analysis of pain measurement on day 7 postoperatively for the use of non-steroidal anti-inflammatory drugs.
Fig. 9
Fig. 9
Forest plot for meta-analysis of postoperative nausea and vomiting for the use of steroids.
Fig. 10
Fig. 10
Forest plot for the meta-analysis of primary postoperative bleeding for the use of steroids.
Fig. 11
Fig. 11
Forest plot for meta-analysis of secondary postoperative bleeding for the use of steroids.
Fig. 12
Fig. 12
Forest plot for meta-analysis of pain measurement within the first 24 h for the use of steroids.
Fig. 13
Fig. 13
Forest plot for meta-analysis of pain measurement on day 1 postoperatively for the use of steroids.
Fig. 14
Fig. 14
Forest plot for the meta-analysis of pain measurement on the third postoperative day for the use of steroids.
Fig. 15
Fig. 15
Forest plot for meta-analysis of pain measurement on day 7 postoperatively for the use of steroids.
Fig. 16
Fig. 16
Forest plot for meta-analysis for postoperative nausea and vomiting for the use of local anaesthetics.
Fig. 17
Fig. 17
Forest plot for meta-analysis for primary postoperative bleeding for the use of local anaesthetics.
Fig. 18
Fig. 18
Forest plot for meta-analysis for secondary postoperative bleeding for the use of local anaesthetics.
Fig. 19
Fig. 19
Forest plot for meta-analysis of pain measurement within the first 24 h for the use of local anaesthetics.
Fig. 20
Fig. 20
Forest plot for meta-analysis of pain measurement on the first postoperative day for the use of local anaesthetics.
Fig. 21
Fig. 21
Forest plot for meta-analysis of pain measurement on the third postoperative day for the use of local anaesthetics.
Fig. 22
Fig. 22
Forest plot for meta-analysis of pain measurement on the 7th postoperative day for the use of local anaesthetics.
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