A Cochrane review [Abstract] 1 included 7 studies with a total of (593 participants; 397 children and 196 adults). Patients in all studies had been previously admitted for elective tonsillectomy. Interventions were delivered by spray in 5 trials and by mouth rinses in one trial. Benzydamine hydrochloride was used in 5 trials and lidocaine and hydrogen peroxide both in one trial. They were compared with normal saline spray, water and unspecified placebo. The period of follow-up ranged from 24 hours to 2 weeks. Few of the trials provided reliable data for the pre-specified primary outcomes and none provided data for the time to complete resolution of pain, an important patient outcome. Lidocaine spray appeared to be more effective than saline spray at reducing the severity of pain but only until the third postoperative day (2.0 lower, 95% CI 1.21 to 2.79; one trial, n=40). A small number of participants experienced a burning or stinging sensation with benzydamine spray but not sufficient to discontinue usage.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), inconsistency (heterogeneity in treatments and outcomes), indirectness (differences in outcomes) and imprecise results (limited study size for comparisons).
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