Adjuncts to local anaesthetics in tonsillectomy: a systematic review and meta-analysis

Abstract

The infiltration of local anaesthetic agents has been shown to reduce post-tonsillectomy pain. A number of recent studies have shown that the addition of agents such as clonidine and dexamethasone improve the efficacy of nerve blocks and spinal anaesthesia. The aim of this review was to determine whether additives to local anaesthetic agents improve post-tonsillectomy outcomes. Four major databases were systematically searched for all relevant studies published up to August 2016. All study designs with a control group receiving local anaesthetic infiltration and an intervention receiving the same infiltration with an added agent were included in this review. These studies were then assessed for level of evidence and risk of bias. The data were then analysed both qualitatively and where appropriate by meta-analysis. We reviewed 11 randomised controlled trial (RCTs) that included 854 patients. Due to inconsistencies in the methods used to report outcomes, both quantitative and qualitative comparisons were required to analyse the extracted data. Overall, we found that dexamethasone, magnesium, pethidine and tramadol reduce post-operative pain and analgesia use, with dexamethasone in particular significantly reducing post-operative nausea and vomiting and magnesium infiltration significantly reducing the incidence of laryngospasm. This systematic review of RCTs provides strong evidence that the use of dexamethasone and magnesium as additives to local anaesthetics reduces post-tonsillectomy pain and analgesia requirement. There is limited evidence that pethidine and tramadol have a similar effect on pain and analgesia requirement. The studies in this pooled analysis are sufficiently strong to make a level one recommendation that the addition of magnesium to local anaesthetics reduces the incidence of laryngospasm, a potentially lethal post-operative complication. Review level of evidence: 1.

Role of Dexamethasone in Peri-operative Anesthesia Management: A Review of Literature

“…Moeen et al have shown in their study done during transurethral prostatectomy that intrathecal dexamethasone was as effective as intrathecal meperidine in attenuation of shivering compared to placebo under spinal anesthesia with less adverse events. The number of patients with shivering was higher in Group Control (C) (13) than in Group Dexamethasone (D) (2) and Group Mepridine (M) (3) with no differences between Group D and M; p=0.001. Intensity and recurrence of shivering and dose of IV meperidine used to treat shivering were higher in Group C compared to Group D and Group M; p=0.01, p =0.064, and p=0.004, respectively.…”

“…1 Vlok found that there is a significant reduction in post-operative nausea and vomiting and post-operative pain as compared to tramadol, pethidine, magnesium sulphate and tramadol. 2 Sehavat et al suggested that a single prophylactic dose of dexamethasone 8 mg after an operation can reduce postoperative nausea and vomiting. 3 Naryanappa et al suggested that combination of dexamaethasone and ramosetron is more effective than palonosetron in PONV prevention, and they did their study in gynecological surgeries under spinal anesthesia.…”

Role of Dexamethasone in Peri-operative Anesthesia Management: A Review of Literature

“…1 Vlok found that there is a significant reduction in post-operative nausea and vomiting and post-operative pain as compared to tramadol, pethidine, magnesium sulphate and tramadol. 2 Sehavat et al suggested that a single prophylactic dose of dexamethasone 8 mg after an operation can reduce postoperative nausea and vomiting.…”

“…In the largest ENIGMA II TRIAL, there were registered 5499 subjects, and it was found that dexamethasone administration was associated with a decrease in fever on days [1][2][3] 31 And it was concluded that dexamethasone administration to high-risk non-cardiac surgical patients did not increase the risk of post-operative wound infection or other adverse events up to day 30, and appears to be safe in patients either with or without diabetes mellitus. Also in retrospective analysis done by Richardson et al, a single intravenous peri-operative dose of dexamethasone had no statistically significant difference in the rate of post-operative joint infections after total hip or knee arthroplasty.…”

Tramadol as an adjunct to intra‐articular local anaesthetic infiltration in knee arthroscopy: a systematic review and meta‐analysis

“…6 In an effort to reduce post-operative pain and the repercussions associated with it, research is currently focused on refining local anaesthetic (LA) regimens, in preference to an increased reliance on systemic opioids. 1,[6][7][8][9][10] knee arthroscopy, there are currently no systematic reviews or meta-analyses on the topic. The primary aim of this systematic review and meta-analysis was to investigate whether or not tramadol, when used as an adjunct to IA LA infiltration, improves postoperative pain scores when compared with alternative regimens.…”