@article{9a15fcbb69a84eb982570ed855ba2b2a,
title = "PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations",
abstract = "Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure-specific efficacy as well as specific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta-analysis guidelines with procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre-operative and intra-operative interventions that improved postoperative pain were paracetamol; non-steroidal anti-inflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra-operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the first-line analgesics are contra-indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.",
keywords = "analgesia, evidence-based medicine, pain, systematic review, tonsillectomy",
author = "{the PROSPECT Working Group collaborators*} and N. Aldamluji and A. Burgess and E. Pogatzki-Zahn and J. Raeder and H. Beloeil and E. Albrecht and H. Beloeil and F. Bonnet and S. Freys and Joshi, {G. P.} and H. Kehlet and P. Lavand{\textquoteright}homme and P. Lirk and D. Lobo and E. Pogatzki-Zahn and N. Rawal and J. Raeder and A. Sauter and S. Schug and {van de Velde}, M.",
note = "Funding Information: We thank M. Stone (Clinical Effectiveness Librarian, University Hospitals of North Midlands NHS Trust). PROSPECT is supported by an unrestricted grant from the European Society of Regional Anaesthesia and Pain Therapy (ESRA). In the past, PROSPECT had received unrestricted grants from Pfizer Inc. New York, NY, USA and Grunenthal, Aachen, Germany. GJ has received honoraria from Baxter and Pacira Pharmaceuticals. FB has received honoraria from Pfizer, The Medicine Company, Abbott France and Nordic Pharma France. HK has received honoraria from Pfizer and Grunenthal. The Anesthesiology Unit of the University of Western Australia, but not SS personally, has received research and travel funding and speaking and consulting honoraria from bioCSL, Eli Lilly, Indivior, iX Biopharma and Pfizer. NR has received honoraria from Baxter and Sintetica. MVdV has received honoraria from Sintetica, Grunenthal, Vifor Pharma, MSD, Nordic Pharma, Janssen Pharmaceuticals, Heron Therapeutics and Aquettant. HB has received honoraria from Orion, Abbvie and Aspen. No other competing interests declared. Funding Information: We thank M. Stone (Clinical Effectiveness Librarian, University Hospitals of North Midlands NHS Trust). PROSPECT is supported by an unrestricted grant from the European Society of Regional Anaesthesia and Pain Therapy (ESRA). In the past, PROSPECT had received unrestricted grants from Pfizer Inc. New York, NY, USA and Grunenthal, Aachen, Germany. GJ has received honoraria from Baxter and Pacira Pharmaceuticals. FB has received honoraria from Pfizer, The Medicine Company, Abbott France and Nordic Pharma France. HK has received honoraria from Pfizer and Grunenthal. The Anesthesiology Unit of the University of Western Australia, but not SS personally, has received research and travel funding and speaking and consulting honoraria from bioCSL, Eli Lilly, Indivior, iX Biopharma and Pfizer. NR has received honoraria from Baxter and Sintetica. MVdV has received honoraria from Sintetica, Grunenthal, Vifor Pharma, MSD, Nordic Pharma, Janssen Pharmaceuticals, Heron Therapeutics and Aquettant. HB has received honoraria from Orion, Abbvie and Aspen. No other competing interests declared. Publisher Copyright: {\textcopyright} 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists",
year = "2021",
month = jul,
doi = "10.1111/anae.15299",
language = "English (US)",
volume = "76",
pages = "947--961",
journal = "Anaesthesia",
issn = "0003-2409",
publisher = "Wiley-Blackwell",
number = "7",
}