Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults
| Autor: | Katri Hamunen, H.K. Tolska, Vesa P. Kontinen, Annika Takala |
|---|---|
| Přispěvatelé: | Anestesiologian yksikkö, HUS Perioperative, Intensive Care and Pain Medicine, University of Helsinki, Vesa Kontinen / Principal Investigator, University Management, Department of Pharmacology |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Ketoprofen DEXTROMETHORPHAN Analgesic Anti-Inflammatory Agents Cochrane Library Dexamethasone DOUBLE-BLIND 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Parecoxib Lornoxicam medicine PARACETAMOL Humans multimodal analgesia Ketamine Rofecoxib Tonsillectomy RISK Analgesics Pain Postoperative business.industry NONSTEROIDAL ANTIINFLAMMATORY DRUGS KETOPROFEN EFFICACY 3126 Surgery anesthesiology intensive care radiology REDUCES PAIN 3. Good health Anesthesiology and Pain Medicine POSTOPERATIVE PAIN adolescent GABAPENTIN/PREGABALIN Anesthesia Celecoxib Pain in Specific Situation business medicine.drug |
| Zdroj: | British Journal of Anaesthesia. 123:e397-e411 |
| ISSN: | 0007-0912 |
| DOI: | 10.1016/j.bja.2019.04.063 |
| Popis: | Background Intense pain can last several days after tonsillectomy. It is often undertreated and improved analgesic strategies that can be safely used at home are needed. Methods We conducted a systematic review and meta-analysis on the effectiveness of systemic medications used for post-tonsillectomy pain in adult and adolescent (13 yr old) patients. Studies were identified from PubMed, the Cochrane Library, and by hand searching reference lists from studies and review articles. Randomised, double-blind, placebo-controlled studies reporting on pain intensity or use of rescue analgesia were included. Results Twenty-nine randomised controlled trials representing 1816 subjects met the inclusion criteria. Follow-up time was ≤24 h in 15 studies, in which the majority were taking nonsteroidal anti-inflammatory drugs. Thirteen studies were suitable for meta-analysis. In pooled analysis, paracetamol, dexamethasone, and gabapentinoids reduced pain intensity on the day of operation. In individual studies, ketoprofen, ibuprofen, lornoxicam, parecoxib, rofecoxib, indomethacin and dextromethorphan reduced pain intensity, need for rescue analgesics, or both on the day of operation. Oral celecoxib for 2 postoperative weeks or i.v. ketamine on the day of operation were not effective at the studied doses. Dexamethasone in multiple doses provided analgesia beyond 1 postoperative day. Pain was moderate to strong in both study and control groups during the first postoperative week. Conclusions Single analgesics and dexamethasone provide only a weak to moderate effect for post-tonsillectomy pain on the day of operation and thus a multimodal analgesic strategy is recommended. Short follow-up times and clinical heterogeneity of studies limit the usefulness of results. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|