Nonpharmacologic Therapy for Pediatric Posttonsillectomy Pain: A Systematic Review

OBJECTIVE: To understand efficacies of nonpharmacologic therapy for pediatric posttonsillectomy pain. DATA SOURCES: CINAHL, Cochrane Library, PubMed, and Scopus. REVIEW METHODS: Studies on nonpharmacologic interventions for pediatric posttonsillectomy pain were included in this systematic review. Extracted variables included demographics, pain scores, and postoperative bleeding. Pain scores on 0-10 scales (eg, Visual Analog Scale, Wong-Baker, FLACC, Oucher) were analyzed, and scales using different ranges, but comparable pain markers, were standardized to 0 to 10. Data were summarized as means, proportions (%), and differences (Δ) with 95% confidence intervals (CI). Risk of bias was evaluated using the Joanna Briggs Institute (JBI), ROBINS-I, or ROB-2 tools. RESULTS: Twenty-three studies (n = 3538) met inclusion criteria. Several nonpharmacologic intervention groups showed significant reductions in postoperative pain compared to control. At 6 hours postoperatively, acupuncture (∆ -0.8, 95% CI [-1.17, -0.43], P < .01), ice cream (∆ -1.4, 95% CI [-2.28, -0.52], P < .01), cartoon distraction (∆ -1.3, 95% CI [-1.83, -0.77], P < .01), and lavender essence inhalation (∆ -0.9, 95% CI [-1.76, -0.04], P = .04), were associated with lower pain scores. By postoperative Day 7 sugar-free gum was the only intervention associated with lower pain scores (∆ -2.2, 95% CI [-3.07, -1.33], P < .01). Salvia officinalis, cold diet, and food and effort restrictions were associated with less postoperative bleeding. Honey, intraoperative music, autologous serum, and liquid/soft diet (among other interventions) showed no changes in postoperative pain. CONCLUSIONS: Nonpharmacologic interventions including acupuncture, sugar-free gum, distraction, and select oil essence therapies are associated with less pain, with some interventions reducing postoperative bleeding risk. This supports incorporating non-pharmacologic adjuncts for pediatric posttonsillectomy pain, though further high-quality studies are needed.