Albazee Ebraheem, Elsnhory Ahmed Bostamy, Abdelaziz Ahmed, Alsakka Mahmoud Abdelaziz, Abu-Zaid Ahmed
Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait.
Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):4587-4595. doi: 10.1007/s12070-024-04928-w. Epub 2024 Jul 25.
To assess the effectiveness of glossopharyngeal nerve block (GNB) in the treatment of postoperative pain among patients undergoing tonsillectomy, a systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Various databases, including PubMed, Cochrane, Scopus, Web of Science, and Google Scholar, were systematically screened from inception until March 2023. The included studies were assessed using the RoB-2 tool. The outcomes of interest included reporting on at least one of the predetermined efficacy and safety endpoints, such as postoperative pain, the severity of swallowing, and the incidence of postoperative complications such as bleeding, nausea and vomiting, hoarseness, nasal obstruction, dyspnea, foreign body sensation, and dry mouth. Dichotomous data were collected as risk ratios (RR), and continuous data were collected as standardized mean differences (SMD). The overall analyses were conducted using a random-effects model. In total, 492 participants were enrolled in our investigation, with 245 and 247 participants allocated to the GNB and control arms, respectively. When comparing postoperative pain levels during rest and swallowing, the GNB arm showed a significantly reduced effect size compared to the control arm ( = 5 RCTs, SMD= -1.38, 95% CI [-1.82, -0.94], < 0.001; = 4 RCTs, SMD= -1.43, 95% CI [-2.15, -0.72], < 0.001), respectively. Overall, there was no substantial variation in effect size between the GNB and control arms with regard to the severity of difficulty in swallowing ( = 0.7). Additionally, there were no significant differences observed between the GNB and control groups in terms of postoperative complications endpoints ( > 0.05). This thorough analysis showed that GNB had both statistical and clinical advantages for patients after a tonsillectomy. It was found that GNB was an effective, safe, and straightforward method for managing early postoperative pain.
The online version contains supplementary material available at 10.1007/s12070-024-04928-w.
为评估舌咽神经阻滞（GNB）在扁桃体切除术后患者疼痛治疗中的有效性，我们对随机对照试验（RCT）进行了系统评价和荟萃分析。从数据库建立至2023年3月，我们系统检索了包括PubMed、Cochrane、Scopus、Web of Science和谷歌学术在内的多个数据库。采用RoB - 2工具对纳入研究进行评估。感兴趣的结局包括报告至少一项预先确定的疗效和安全性终点，如术后疼痛、吞咽严重程度以及术后并发症（如出血、恶心和呕吐、声音嘶哑、鼻塞、呼吸困难、异物感和口干）的发生率。二分数据以风险比（RR）收集，连续数据以标准化均数差（SMD）收集。总体分析采用随机效应模型。我们的研究共纳入492名参与者，分别有245名和247名参与者被分配至GNB组和对照组。在比较休息和吞咽时的术后疼痛水平时，GNB组与对照组相比效应量显著降低（休息时：n = 5项RCT，SMD = -1.38，95%CI [-1.82, -0.94]，P < 0.001；吞咽时：n = 4项RCT，SMD = -1.43，95%CI [-2.15, -0.72]，P < 0.001）。总体而言，GNB组和对照组在吞咽困难严重程度方面的效应量无实质性差异（I² = 0.7）。此外，GNB组和对照组在术后并发症终点方面未观察到显著差异（P > 0.05）。这项全面分析表明，GNB对扁桃体切除术后患者具有统计学和临床优势。研究发现，GNB是一种有效、安全且简便的早期术后疼痛管理方法。
在线版本包含可在10.1007/s12070 - 024 - 04928 - w获取的补充材料。
