Oral rinses, mouthwashes and sprays for improving recovery following tonsillectomy

 

Abstract

Background

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2010.

Tonsillectomy is the surgical removal of lymphoid tissue, the palatine tonsil, which is located at the back of the throat. It is still commonly performed for patients who have recurrent bouts of acute tonsillitis. Although tonsillectomy is considered a fairly minor procedure, pain and bleeding are two of the most common complications; either may delay recovery and can on occasion lead to hospital readmission. Postoperative tonsillectomy medication should provide an adequate reduction in morbidity while minimising side effects, therefore topical agents would seem to be an ideal, safe option. A number of mouthwashes and topical sprays are available which offer pain relief or can help to reduce bleeding in the immediate postoperative period.

Objectives

To assess the effects of oral rinses, mouthwashes and sprays in improving recovery following tonsillectomy.

Search methods

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 22 April 2011.

Selection criteria

We included randomised controlled trials in which mouthwashes, used pre- and postoperatively, have been compared with placebo.

Data collection and analysis

Two review authors selected trials for inclusion, assessed the risk of bias and extracted data independently.

Main results

We included six trials (528 participants; 397 children and 131 adults). The period of follow up ranged from 24 hours to two weeks. Few of the trials provided reliable data for the pre-specified primary outcomes and none for the secondary outcomes. Lidocaine spray appeared to be more effective than saline spray at reducing the severity of pain but only until the third postoperative day. A small number of participants experienced a burning or stinging sensation with benzydamine spray but not sufficient to discontinue usage.

Authors' conclusions

The risk of bias was high in most of the included trials and poor reporting quality and inadequate data did not permit comprehensive and reliable conclusions to be made. Future trials should be well-constructed and pay more attention to the methods used to assess outcomes, the timing of the assessments, and the quality of reporting and subsequent analysis of the data.

 

Plain language summary

Oral rinses and mouthwashes for improving outcomes following tonsillectomy

Although tonsillectomy is considered to be a fairly minor procedure, pain and bleeding are two of the most common complications; either may delay recovery and can on occasion lead to hospital readmission. Postoperative tonsillectomy medication should aim to minimise some of these symptoms. A number of mouthwashes and topical sprays are available which offer pain relief or can help to reduce bleeding in the period just after surgery. This review, which included six studies involving 528 participants, found that lidocaine spray appeared to be more effective than a placebo NaCl (saline) spray at reducing the severity of pain but only until the third postoperative day. A small number of participants experienced a burning or stinging sensation when they used another spray containing benzydamine but this was not sufficient to discontinue its usage.

Further research should aim to provide reliable evidence for people to make informed decisions as to whether these treatments can be effective in reducing the most common symptoms and complications following tonsillectomy.

 

摘要

背景

口腔清洗劑 (Oral rinses) 、漱口水 (mouthwash) 以及噴劑 (spray) 用於改善扁桃腺切除 (tonsillectomy) 術後的恢復

扁桃腺切除是以手術方式切除淋巴組織，意即切除位於喉嚨後方的顎扁桃體。這仍是針對反覆急性扁桃腺炎(acute tonsillitis)發作的患者經常施行的手術。雖然扁桃腺手術被視為相當小的手術，但是痛及出血是兩個最常見的術後併發症，而這兩個併發症中的任一個，都可能延長恢復，而且偶而可能造成病人再次入院。扁桃腺切除術的用藥應該是要減少合併症同時減低藥物副作用，因此局部藥物使用似乎是個理想且安全的選擇。在術後可以立即使用一些漱口水及局部噴劑來緩解疼痛或是幫助減少出血。

目標

評估口腔清洗劑，漱口水以及噴劑用於改善扁桃腺切除術後的恢復。

搜尋策略

我們搜尋了Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL, PubMed; EMBASE; CINAHL; AMED; ISI Web of Science; BIOSIS Previews; CAB Abstracts; LILACS; KoreaMed; IndMed; PakMediNet; China National Knowledge Infrastructure; NRR (National Research Register) Archive; mRCT (the metaRegister of Controlled Trials) 以及 Google，2009年3月以前的文章。

選擇標準

我們收納在術前及術後使用漱口水跟安慰組 (placebo) 比較的隨機對照試驗(randomised controlled trial)。

資料收集與分析

由兩位作者挑選要收納的試驗，評估偏差的風險及獨立地擷取資料。

主要結論

我們收納了總共6篇試驗，包含528位病人 (397位小孩及131位成人) ，追蹤期間從24小時到2週，少數的文獻提供可靠的事先訂出來的第一結果的數據，而沒有文獻提供第二結果的數據。Lidocaine噴劑止痛效果優於生理食鹽水不過只有術後三天內才有這種結果。少數病人使用Benzydamine噴劑時會有燒灼感或刺痛感，不過還不至於使病人停止使用。

作者結論

在大部分收納的試驗都有高的偏差的風險，而且因為不良的報告以及資料不充足，所以無法得出完整可靠的結論。未來的試驗應該要有更好的設計，並且著重於評估結果的方法，評估的時間點，報告的品質以及結果的後續分析。

翻譯人

本摘要由基隆長庚醫院沈芳瑩翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

口腔清洗劑以及漱口水用於改善扁桃腺切除術後的結果：雖然扁桃腺手術被視為相當小的手術，但是痛及出血是兩個最常見的併發症，而這兩個併發症中的任一個，都可能延長恢復，而且偶而可能造成病人再次入院。扁桃腺切除術的用藥的目的應該是在減低這些症狀。在術後可以立即使用一些漱口水及局部噴劑來緩解疼痛或是幫助減少出血。在這篇收納了總共6篇文獻，包含528位病人，發現使用Lidocaine噴劑比安慰劑NaCl (生理食鹽水) 在止痛方面更有效，不過只有到了術後三天內才有這種結果。少數病人使用含有Benzydamine噴劑表示有燒灼感或刺痛感，不過這樣的不適還不至於使病人停止使用。未來的研究應該要致力於提供更可靠的證據，讓人們了解這些治療是否可以有效地減少大部分常見的桃腺切除術後症狀及併發症，而決定是否接受治療。