Vlok R, Melhuish T M, Chong C, Ryan T, White Leigh D
Wagga Wagga Rural Referral Hospital, Wagga Wagga, NSW, Australia.
School of Medicine, Sydney, University of Notre Dame, Fremantle, NSW, Australia.
J Anesth. 2017 Aug;31(4):608-616. doi: 10.1007/s00540-017-2310-x. Epub 2017 Jan 24.
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.
局部麻醉剂的浸润已被证明可减轻扁桃体切除术后的疼痛。最近的一些研究表明，添加可乐定和地塞米松等药物可提高神经阻滞和脊髓麻醉的效果。本综述的目的是确定局部麻醉剂的添加剂是否能改善扁桃体切除术后的预后。系统检索了四个主要数据库，以查找截至2016年8月发表的所有相关研究。本综述纳入了所有研究设计，其中对照组接受局部麻醉浸润，干预组接受相同浸润并添加了一种药物。然后对这些研究进行证据水平和偏倚风险评估。然后对数据进行定性分析，并在适当情况下进行荟萃分析。我们回顾了11项随机对照试验（RCT），共纳入854例患者。由于报告结果的方法不一致，因此需要进行定量和定性比较来分析提取的数据。总体而言，我们发现地塞米松、镁、哌替啶和曲马多可减轻术后疼痛并减少镇痛药物的使用，尤其是地塞米松可显著减少术后恶心和呕吐，镁浸润可显著降低喉痉挛的发生率。这项对RCT的系统评价提供了强有力的证据，表明使用地塞米松和镁作为局部麻醉剂的添加剂可减轻扁桃体切除术后的疼痛并减少镇痛需求。关于哌替啶和曲马多对疼痛和镇痛需求有类似作用的证据有限。这项汇总分析中的研究足够有力，可做出一级推荐，即局部麻醉剂中添加镁可降低喉痉挛的发生率，喉痉挛是一种潜在致命的术后并发症。综述证据水平：1级。
