Recent advances in post-tonsillectomy analgesia

Abstract: Although tonsillectomy is a common and relatively safe procedure, postoperative pain after tonsillectomy is so severe that it impairs perioperative recovery disorder. Acute pain can also cause physical discomfort, anxiety, and even behaviour problems, and high-quality acute pain management can promote functional recovery and improve long-term functional outcomes. Despite recent efforts, it is still very difficult to provide sufficient analgesia for most patients due to the special operation site and the limitation of the existing analgesia program. Postoperative pain after tonsillectomy has two components: constant pain and swallow-evoked pain. Surgical intervention in the site of the tonsils might affect local muscles directly or indirectly through circulus tonsillaris nervous plexus. Although numerous drug comparison studies are being performed in this field, its postoperative analgesia programs remain controversial. The GPN is a mixed nerve that contains 3 components including the sensory, motor, and parasympathetic nerve fibres. Theoretically, the GPN block provides us with a direct way to block pain conduction. At present, post-tonsillectomy analgesia in most medical centers is based on analgesic agents, although there have been reports on the use of ultrasound-guided glossopharyngeal nerve (GPN) block. Post-tonsillectomy analgesia has attracted wide attention from multiple disciplines. This article systematically elucidates the various analgesics and methods used in post-tonsillectomy analgesia and explores the feasibility of ultrasound-GPN block, with an attempt to provide new insights for multimodal post-tonsillectomy analgesia.