Abstract:
Background: Tonsillectomy is defined as the surgical excision of tonsils by completely removing it including its capsule from the muscular wall1. It’s considered one of the most common surgical procedures with over 500,000 cases annually. Bleeding post tonsillectomy is one of the most serious complication. injectable local epinephrine consider on of the most effective method to control intra-operative bleeding in oral surgery, for which the current study highlight the effect of it on tonsillectomy procedures. Methods: This systematic review and subsequent meta-analysis were carried out following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The following online databases were searched from inception to January 2024. This analysis aimed to identify related randomized clinical trials (RCTs) from MEDLINE, PubMed, Scopus, Cochrane, Web of Science. An initial search of the five electronic databases yielded 322 potential studies. The data was screened in two stages; title-based and full-text reviews. Based on the PRISMA checklist and guidelines, full-text articles were retrieved and screened. 14 randomized clinical trials remained after exclusions. Results: The fourteen eligible, randomized control trial studies included a total of 876 patients who underwent tonsillectomy with injectable local epinephrine, with or without analgesic agents. Out of these, 545 patients received epinephrine with an analgesic agent (study group) and 495 patients received the placebo (control group). Out of the 14 included studies, 10 studies reported the amount of intra and post-operative bleeding (Epinephrine, 392 patients; Placebo, 393 patients). The use of epinephrine with different analgesic agents significantly reduced the amount of intra and post-operative bleeding. 11 studies have reported the pain scores of the patients, post-tonsillectomy (Epinephrine, 339 patients; Placebo, 349 patients). The use of epinephrine with different analgesics has significantly proved to reduce the pain of the patients after the operation and during the recovery period. Conclusion: In the current study, it shows that injectable local epinephrine during tonsillectomy have a significant effect on decreasing intra-operative bleeding, pain score, operation time, and post-operative recovery. For which the current study recommends the use injectable local epinephrine during tonsillectomy safely, to reduce tonsillectomy related complication.
