Efficacy of Topical Analgesics Used Perioperatively for Pain Control After Tonsillectomy: A Systematic Review

Abstract Posttonsillectomy pain is most pronounced during the first few days postoperatively and may persist for up to 1 week. In children, analgesic strategies have to facilitate oral intake and hydration, while also minimizing the use of opioids. Despite the importance of pain management strategies, no study has evaluated the effectiveness of analgesics used after tonsillectomy or compared their effects across specific time periods. Therefore, this systematic review aimed to evaluate the effectiveness of topical analgesics used before and after tonsillectomy by summarizing the available published perioperative evidence on the use of topical analgesics after tonsillectomy and analyzing descriptive effectiveness patterns based on the route and timing of administration in the postoperative period. A systematic review and meta-analysis were conducted using available databases such as PubMed/MEDLINE, the Cochrane Library, Web of Science, EBSCOpost, and Google Scholar. The review examined randomized controlled trials (RCTs) of children and adults who underwent tonsillectomy. This review was conducted as of December 2025, using the earliest available date for each database and up to the most recent available date. The review included 11 studies (2003–2025) RCT, observational studies, and systematic reviews that investigated the relationship between tonsillectomy, postoperative pain, and topical analgesia. To assess outcomes and measure pain, the Face, Legs, Activity, Cry, Consolability scale for children, the Wong–Baker FACES scale, and the Visual Analogue Scale (VAS) for adults were used. Statistical analysis was performed using the Open Meta (analyst) meta-analysis package. The results showed that among the RCTs, four had a low risk of bias, while the others had moderate risks/some concerns, mostly related to issues surrounding the randomization and the blinding of outcome measures to subjective pain. These also showed a marked diversity, primarily focusing on lidocaine (LIDO) use via different routes. The review concluded that compared with saline, LIDO administration following tonsillectomy was associated with a statistically significant reduction in postoperative pain, particularly in the early recovery phase, with a pooled mean difference (MD) of approximately −1.2 to −1.5 points on the VAS within the first 24 h. This magnitude of effect meets the threshold for minimal clinically important difference (MCID), indicating a meaningful improvement in patient-reported pain. In contrast, bupivacaine demonstrated a smaller and delayed effect, with modest pain reduction observed at 24 h (MD ≈ −0.5 to −0.8), which may be of limited clinical relevance. However, differences in techniques, comparators, and pain assessment methods lead to moderate-to-high heterogeneity across pooled results.