Abstract
ObjectiveTo analyze the effect of adjuvant oral application of honey for treating postoperative pain after tonsillectomy.DesignSingle centre prospective cohort study.SettingTwo cohorts of patients after tonsillectomy.Participants56 patients treated with honey 8 times per day (honey group), 18 patients treated without honey (control group); baseline analgesia were non-steroidal anti-inflammatory drugs (NSAID) or coxibs; opioids were used as pro re nata (PRN) medication; mean age 34.4 ± 13.4 years; 36% women.Main outcome measuresOn first to fifth postoperative day, patients rated their pain using the validated questionnaire of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale (NRS, 0–10) for determination of patient's pain. QUIPS allows standardized assessment of patients' characteristics andpain-associated patient-reported outcomes (PROs). The influence of preoperative and postoperative parameters on patients' postoperative pain were estimated by univariate and multivariate statistical analysis.ResultsAverage pain in activity in the control group was greater than 4 (NRS 4.4 ± 2.4) during the first five postoperative days, with a renewed increase in pain intensity on the fifth day (4.3 ± 2.5). In the honey group, the pain in activity decreased without any further pain increase and was only higher than 4 on the first three postoperative days (4.3 ± 2.1, all p>0.05). However; neither minimal nor maximal pain were significantly different between both groups on the first postoperative day (p = 0.217, p = 0.980). Over the five postoperative days, the minimal and maximal pain in the honey group decreased continuously and faster than in the control group. With regard to pain-related impairments on the first day, the honey group reported less pain-related sleep disturbance (p = 0.026), as well as significantly fewer episodes of postoperative oral bleeding (p = 0.028) than the control group. Patients without honey consumption had on the first and fifth postoperative day a higher risk of increased minimal pain (OR = -2.424, CI = -4.075 –-0.385). Gender was an independent factor for compliance of honey consumption on the second postoperative day (p = 0.037). Men had a lower probability for compliance of honey consumption (OR = -0.288, CI = -2.863 –-0.090).ConclusionThere was a trend of reduced postoperative pain after oral honey application. Honey also seems to reduce pain-related impairments. The need for additional opioids on the first day could be reduced. A larger controlled trial is now needed to varify the effect of honey on pain after tonsillectomy.Clinical trial registration numberGerman Clinical Trials Register DRKS00006153. The authors confirm that all ongoing and related trials for this drug/intervention are registered.
Highlights
Tonsillectomy, the surgical removal of the palatine tonsils, is still one of the most common surgical procedures in adults in Germany and around the world [1]
Men had a lower probability for compliance of honey consumption (OR = -0.288, CI = -2.863 –-0.090)
There was a trend of reduced postoperative pain after oral honey application
Summary
Tonsillectomy, the surgical removal of the palatine tonsils, is still one of the most common surgical procedures in adults in Germany and around the world [1]. Even though patients receive such a combination therapy postoperative pain after tonsillectomy remains at a high level and an improved therapy plan is needed [8, 9, 10]. Different factors contribute to postoperative pain after tonsillectomy: the dense innervation with pain fibers in the area of tonsils [11], mediators of inflammation like bradykinin or prostaglandins, which irritate sensitive nerve endings and induce strong pain [12, 13], local infiltration of neutrophile granulocytes and cytokines [14]. Honey seems to have a comparable effect to topic antibiotics on pathogenic bacterial infections of surgical wounds and conjunctiva [15]. Honey might affect the local inflammation and thereby reduce und diminish duration of wound pain. The studies performed so far studying the effect of honey
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