Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
Core facility of West China Hospital, Sichuan University, Chengdu, China.
Eur Arch Otorhinolaryngol. 2024 Nov;281(11):5641-5649. doi: 10.1007/s00405-024-08817-4. Epub 2024 Jul 28.
To assess the effect of intraoperative cryoanalgesia on subjective pain scores of patients after tonsillectomy.
A systematic review of PubMED, Web of Science, EMBASE was performed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) standards. For the first time, we included and quantitative synthesized English-language randomized controlled trials (RCT) evaluating patients of all age groups with benign pathology who underwent tonsillectomy with intraoperative cryoanalgesia versus without.
A total of 835 publications were identified, and 7 articles with 463 participants met our criteria were selected for meta-analysis. The standard mean difference for overall subjective pain score, subjective pain scores at postoperation Day1 (POD1), POD7 were -1.44 with 95% confidence interval (CI) [-2.17, -0.72], P = .0001; -1.20 with 95% CI [-1.89, -0.50], P = .0007; -0.90 with 95% CI [-1.46, -0.35], P = .001 respectively, both in favor of cryoanalgesia. Nevertheless, subgroup analysis by surgical technique showed no robust effect between hot technique and "relative" hot technique on overall pain: (-1.72, 95% CI [-2.71, -0.73]) vs. (-1.06, 95% CI [-2.20, 0.07]), p=.39; on POD1: (-1.56, 95% CI [-2.78, -0.33]) vs. (-0.97, 95% CI [-1.83, -0.11]), p=.39; and on POD7 (-1.11, 95% CI [-1.81, -0.40]) vs. (-0.89, 95% CI [-2.02, 0.25]), p=.13. The standard mean difference for postoperative secondary bleeding rate was 1.29 with 95% CI 0.37,4.52], p = .06, no difference in 2 groups.
Limited evidence suggests that intraoperative cryoanalgesia during tonsillectomy leads to lower subjective pain score on overall, POD1 and POD7 without differences on post-operation bleeding rate.
评估术中冷冻镇痛对扁桃体切除术后患者主观疼痛评分的影响。
采用 PRISMA 标准对 Pubmed、Web of Science、EMBASE 进行系统评价。我们首次纳入并对评估接受术中冷冻镇痛的良性病理扁桃体切除术患者的所有年龄段患者的英语随机对照试验（RCT）进行了定量综合分析。
共确定了 835 篇出版物，其中 7 篇符合条件的文章（463 名患者）被纳入荟萃分析。总体主观疼痛评分的标准均数差为-1.44，95%置信区间（CI）为[-2.17，-0.72]，P=0.0001；术后第 1 天（POD1）的主观疼痛评分-1.20，95%CI[-1.89，-0.50]，P=0.0007；POD7 的主观疼痛评分-0.90，95%CI[-1.46，-0.35]，P=0.001，均有利于冷冻镇痛。然而，手术技术的亚组分析显示，在总体疼痛方面，热技术与“相对”热技术之间没有明显的效果差异：-1.72，95%CI[-2.71，-0.73]）vs.-1.06，95%CI[-2.20，0.07]），P=0.39；POD1：-1.56，95%CI[-2.78，-0.33]）vs.-0.97，95%CI[-1.83，-0.11]），P=0.39；POD7：-1.11，95%CI[-1.81，-0.40]）vs.-0.89，95%CI[-2.02，0.25]），P=0.13。术后继发性出血率的标准均数差为 1.29，95%CI 为 0.37，4.52]，P=0.06，两组无差异。
有限的证据表明，扁桃体切除术中使用冷冻镇痛可降低整体、POD1 和 POD7 的主观疼痛评分，而术后出血率无差异。
