背景:我们通过对相关文献的荟萃分析,研究了围手术期舌咽神经阻滞对减轻扁桃体切除术患者术后疼痛的作用。
方法:我们从PubMed检索了8项研究,Scopus,Embase,WebofScience,以及截至2023年8月的Cochrane数据库。我们比较围手术期舌咽神经阻滞与对照组,为了检查术后疼痛,镇痛药的使用,和其他术后并发症。
结果:术后1-4h疼痛明显减轻(SMD-1.26,95%CI[-2.35;-0.17],I2=94.7%,P=0.02)和5-8小时(SMD-1.40,95%CI[-2.47;-0.34],I2=96.1%,与对照组相比,治疗组的p=0.01)。然而,与对照组相比,舌咽神经阻滞在12h后没有减轻疼痛或使用镇痛药物的功效。术后出血的发生率(OR0.95,95%CI[0.35;2.52],I2=0.0%),局部药剂毒性(OR4.14,95%CI[0.44;38.63],I2=0.0%),鼻腔问题(OR1.25,95%CI[0.60;2.61],I2=0.0%),术后恶心和呕吐(OR1.35,95%CI[0.78;2.33],I2=0.0%),吞咽困难(OR1.61,95%CI[0.76;3.42],I2=56.0%),和语音变化(OR3.11,95%CI[0.31;30.80],I2=0.0%)在治疗组和对照组之间没有显着差异。与对照组相比,治疗组的呼吸问题和口干患病率更高,但无统计学意义。但显著增加咽喉不适(p=0.02)。
结论:口内舌咽神经阻滞用于扁桃体切除术对术后疼痛管理没有显著影响,并与一些不良反应和呼吸问题的增加有关。口干,与对照组相比,喉咙不适。
BACKGROUND: We investigated the role of perioperative intraoral glossopharyngeal nerve block to minimize postoperative pain in patients undergoing tonsillectomy through a meta-analysis of the relevant literature.
METHODS: We retrieved eight studies from PubMed, Scopus, Embase, Web of Science, and Cochrane databases up to August 2023. We compared perioperative glossopharyngeal nerve block with a control group, in order to examine postoperative pain, analgesic use, and other postoperative morbidities.
RESULTS: Postoperative pain was significantly reduced at 1-4 h (SMD -1.26, 95% CI [-2.35; -0.17], I2 = 94.7%, P = 0.02) and 5-8 hours (SMD -1.40, 95% CI [-2.47; -0.34], I2 = 96.1%, p = 0.01) in the treatment groups compared to the control group. However, glossopharyngeal nerve block showed no efficacy in reducing pain or use of analgesic drugs after 12 h compared to the control group. The incidences of postoperative bleeding (OR 0.95, 95% CI [0.35; 2.52], I2 = 0.0%), local agent toxicity (OR 4.14, 95% CI [0.44; 38.63], I2 = 0.0%), nasal problems (OR 1.25, 95% CI [0.60; 2.61], I2 = 0.0%), postoperative nausea and vomiting (OR 1.35, 95% CI [0.78; 2.33], I2 = 0.0%), swallowing difficulty (OR 1.61, 95% CI [0.76; 3.42], I2 = 56.0%), and voice change (OR 3.11, 95% CI [0.31; 30.80], I2 = 0.0%) were not significantly different between the treatment and control groups. The treatment group showed higher prevalence of respiratory problems and dry mouth compared to control without statistical significance, but a significant increase in throat discomfort (p = 0.02).
CONCLUSIONS: Intraoral glossopharyngeal nerve block for tonsillectomy did not significantly impact postoperative pain management and was associated with some adverse effects with increases in respiratory problems, dry mouth, and throat discomfort compared to controls.