Jules Mead1, Amanda Ullman1, Mary Lang1, Jules Richards1, Jacqui Jauncey-Cooke1, Marie Cooke1
1) Australia
Background & Aim: The aim of the systematic review is to identify any evidence–practice gaps surrounding paediatric tonsillectomy care.
Methods: The review was registered on PROSPERO (CRD42016041281). A systematic search was conducted in October 2016 across online databases. Studies were eligible for inclusion if they were: i) randomised controlled trials; ii) examined pharmacological and non-pharmacological interventions within the pre- peri- or post- operative phase to prevent pain, nausea or vomiting (in the post-operative period) after tonsil removal; iii) involved paediatric patients (< 18 years); iv) published between 2006 - 2016; and iv) in English.
Standard Cochrane Collaboration methods were used including independent review for relevance, data extraction and risk bias assessment of included studies by two review authors. Analyses was undertaken using RevMan software using a random effects model, and involved pair-wise comparisons of treatment effect between intervention types.
Results: Searching identified 794 papers, with 45 studies involving 3,787 participants included in the final analyses. The majority of studies examined the effectiveness of peri-anaesthetic medications to reduce short term pain. Dexamethasone (Intravenous), Ketamine (peri-tonsillar), and Bupivicaine (peri-tonsillar) significantly reduced pain at 6-8 hours, in comparison to placebo (Standardised Mean Difference (SMD) -1.36 [95% CI -1.70, -1.02]; -1.53 [-2.86, -0.19]; -1.04 [-1.83, -0.25] respectively). Peritonsillar Levobupivicaine and Ketamine significantly reduced pain at 18-24 hours, in comparison to placebo (SMD -0.95 [-1.63, -0.26]; -3.78 [-5.21, -2.35] respectively), while there was no significant 18-24 pain reduction in comparison to placebo for peri-tonsillar Ropivicaine or Bupivicaine.
Conclusions: The majority of included studies were at unclear or high risk of bias due to the lack of information surrounding blinding of outcome assessment, randomisation method, and small sample sizes. There is inadequate evidence to suggest any changes to international practice.
Acknowledgements/Disclosures: This project has been supported by funding from Children’s Hospital Foundation Innovation Grant 10418-2
