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

作　　者：Michael C.Shih Barry D.Long Phayvanh P.Pecha David R.White Yi-Chun C.Liu Brennan Emily Mariam I.Nguyen Clarice S.Clemmens 

机构地区：[1]Department of Otolaryngology-Head and Neck Surgery,Medical University of South Carolina,Charleston,South Carolina,USA [2]Baylor College of Medicine,Houston,Texas,USA [3]Department of Otolaryngology-Head and Neck Surgery,Virginia Commonwealth University School of Medicine,Richmond,Virginia,USA [4]Department of Otolaryngology-Head and Neck Surgery,Baylor College of Medicine,Houston,Texas,USA [5]Department of Surgery-Division of Pediatric Otolaryngology,Texas Children's Hospital,Houston,Texas,USA [6]Department of Research and Education Services,Medical University of South Carolina Library,Charleston,South Carolina,USA [7]Charleston County School of the Arts,North Charleston,South Carolina,USA

出　　处：《World Journal of Otorhinolaryngology-Head and Neck Surgery》2023年第1期9-26,共18页世界耳鼻咽喉头颈外科杂志（英文）

摘　　要：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

关 键 词：ADENOTONSILLECTOMY CHILD evidence-based medicine PAIN PEDIATRICS TONSILLECTOMY 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]