#10 Year Challenge Local anaesthetic for post-tonsillectomy pain: update meta-analysis.

INTRODUCTION: Adequate management of post-tonsillectomy pain is an important consideration in postoperative management after tonsillectomy. A 2008 meta-analysis, showed that the use of local anaesthetic either by infiltration or topical application, reduced post-operative pain. OBJECTIVES: To review the current evidence for the use of local anaesthetic as a means of reducing post-tonsillectomy pain and compare current evidence to the previous meta-analysis 10 years ago. METHOD: Systematic literature searches of MEDLINE [*"ANESTHETICS, LOCAL"/ AND *TONSILLECTOMY/], EMBASE [*"LOCAL ANESTHETIC AGENT"/ AND *TONSILLECTOMY/] and PubMed [(Tonsillectomy).ti,ab AND (Local Anaesthetic).ti,ab OR (Local Anesthetic).ti,ab]. A meta-analysis of randomised control trials assessing the use of local anaesthetic agents for post-tonsillectomy pain. RESULTS: Twenty-three studies were included in the meta-analysis. Overall, local anaesthetic, applied topically or infiltrated, significantly reduces pain scores compared with controls at 4-6 h -0.65 (95% CI: -0.77; -0.53)]; 24 hours [-0.50 (95% CI: -0.66, -0.35)] and 5-7 days [-0.78 (95% CI: -0.90, -0.65)] (standardised mean differences). CONCLUSION: Current studies suggest that use of peri-operative local anaesthetic during tonsillectomy does improve post-operative pain outcomes. The limitations of the analysis; all studies are small and a multi-centred larger trial is recommended to guarantee statistical reliability. There were no description of significant adverse side effects from local anaesthetic use.