A scoping review of randomized clinical trials for pain management in pediatric tonsillectomy and adenotonsillectomy

• Published in: World journal of otorhinolaryngology - head and neck surgery Vol. 9; no. 1; pp. 9 - 26
• Main Authors: Shih, Michael C., Long, Barry D., Pecha, Phayvanh P., White, David R., Liu, Yi‐Chun C., Brennan, Emily, Nguyen, Mariam I., Clemmens, Clarice S.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2023; John Wiley and Sons Inc; Wiley
• Subjects: adenotonsillectomy; Age; Analgesics; Anesthesia; Bias; Body mass index; child; Clinical medicine; Clinical trials; Demographics; evidence‐based medicine; Medical personnel; Medical Subject Headings-MeSH; Meta-analysis; Nonsteroidal anti-inflammatory drugs; pain; Pain management; Patients; Pediatrics; Review; Software; Subject heading schemes; tonsillectomy; United States > US; evidence‐based medicine; pain; tonsillectomy; adenotonsillectomy; pediatrics; child
• ISSN: 2095-8811; 2589-1081; 2589-1081
• DOI: 10.1002/wjo2.54

Objectives To examine the volume, topics, and reporting trends in the published literature of randomized clinical trials for pharmacologic pain management of pediatric tonsillectomy and adenotonsillectomy and to identify areas requiring further research. Data Sources PubMed (National Library of Medicine and National Institutes of Health), Scopus (Elsevier), CINAHL (EBSCO), and Cochrane Library (Wiley). Methods A systematic search of four databases was conducted. Only randomized controlled or comparison trials examining pain improvement with a pharmacologic intervention in pediatric tonsillectomy or adenotonsillectomy were included. Data collected included demographics, pain‐related outcomes, sedation scores, nausea/vomiting, postoperative bleeding, types of drug comparisons, modes of administration, timing of administration, and identities of the investigated drugs. Results One hundred and eighty‐nine studies were included for analysis. Most studies included validated pain scales, with the majority using visual‐assisted scales (49.21%). Fewer studies examined pain beyond 24 h postoperation (24.87%), and few studies included a validated sedation scale (12.17%). Studies have compared several different dimensions of pharmacologic treatment, including different drugs, timing of administration, modes of administration, and dosages. Only 23 (12.17%) studies examined medications administered postoperatively, and only 29 (15.34%) studies examined oral medications. Acetaminophen only had four self‐comparisons. Conclusion Our work provides the first scoping review of pain and pediatric tonsillectomy. With drug safety profiles considered, the literature does not have enough data to determine which treatment regimen provides superior pain control in pediatric tonsillectomy. Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of posttonsillectomy pain. The heterogeneity in study design and comparisons weakens the conclusions of potential systematic reviews and meta‐analyses. Future directions include more noninferiority studies of unique comparisons and more studies examining oral medications given postoperatively. For pediatric patients requiring tonsillectomy or adenotonsillectomy, there are many randomized controlled trials examining pain management. However, this scoping review shows a continued need for research in this domain. Specifically, there is a need to standardize reporting methods, study common drugs, and study the efficacy and safety of oral drugs given postoperatively and after 24 h postsurgery. Key points This novel scoping review highlights the heterogeneity of research in pediatric posttonsillectomy pain management. Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of pediatric posttonsillectomy pain.