Intraoral glossopharyngeal nerve block for tonsillectomy fails to significantly impact postoperative pain, suggests study
Recent findings endorse glossopharyngeal nerve block (GNB) as an effective, safe & straightforward approach for managing early postoperative pain in tonsillectomy patients. In a meta-analysis involving 492 patients, GNB significantly reduced pain during rest and swallowing compared to standard care. No major differences were observed in post-op complications, such as nausea, bleeding & hoarseness, between the groups.
They 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. They 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). 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.
Reference:
Kang YJ, Stybayeva G, Hwang SH. Effects of glossopharyngeal nerve block on pain control after tonsillectomy: a systemic review and meta-analysis. ANZ J Surg. 2024 Jun;94(6):1021-1029. doi: 10.1111/ans.18995. Epub 2024 Mar 30. PMID: 38553908.
Keywords:
Kang YJ, Stybayeva G, Hwang SH, Effects, glossopharyngeal nerve block, pain control, tonsillectomy, ANZ Journal of Surgery, adverse effect; meta‐analysis; nerve block; pain; tonsillectomy
