The effect of adjuvant oral application of honey in the management of postoperative pain after tonsillectomy in adults: A pilot study

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.

目的：分析蜂蜜辅助口服疗法对扁桃体切除术后患者术后疼痛的治疗效果。
研究设计：单中心前瞻性队列研究。
研究场景：纳入两批扁桃体切除术后患者队列。
受试者：每日口服蜂蜜8次的蜂蜜组患者56例，未使用蜂蜜的对照组患者18例；基线镇痛方案采用非甾体类抗炎药（non-steroidal anti-inflammatory drugs, NSAID）或昔布类药物（coxibs）；阿片类药物作为按需给药（pro re nata, PRN）药物；受试者平均年龄为34.4±13.4岁；女性占比36%。
主要结局指标：术后第1至第5天，患者采用德国全国性术后疼痛治疗质量改善项目（Quality Improvement in Postoperative Pain Treatment, QUIPS）的经过验证问卷进行疼痛评分，该问卷包含用于评估患者疼痛的数字评分量表（numeric rating scale, NRS，0~10分）。QUIPS可标准化评估患者特征及疼痛相关患者报告结局指标（patient-reported outcomes, PROs）。通过单因素及多因素统计分析，评估术前与术后参数对患者术后疼痛的影响。
结果：术后前5天，对照组患者活动时平均疼痛评分高于4分（NRS评分4.4±2.4），且在第5天疼痛强度再次升高（4.3±2.5）。蜂蜜组患者活动时疼痛评分呈持续下降趋势，未出现疼痛反弹情况，仅在术后前3天疼痛评分高于4分（4.3±2.1，所有p>0.05）。但两组患者术后第1天的最低及最高疼痛评分均无显著差异（p=0.217，p=0.980）。术后5天内，蜂蜜组患者的最低及最高疼痛评分持续下降，且下降速度快于对照组。就术后第1天的疼痛相关不适而言，蜂蜜组患者报告的疼痛相关性睡眠障碍更少（p=0.026），术后口腔出血事件也显著少于对照组（p=0.028）。未服用蜂蜜的患者在术后第1天和第5天出现最低疼痛评分升高的风险更高（比值比OR=-2.424，置信区间CI=-4.075~-0.385）。性别是术后第2天蜂蜜服用依从性的独立影响因素（p=0.037），男性患者的蜂蜜服用依从性更低（OR=-0.288，CI=-2.863~-0.090）。
结论：口服蜂蜜可呈现降低术后疼痛的趋势，同时似乎也可减轻疼痛相关不适。术后首日追加阿片类药物的需求可有所降低。未来需开展更大样本量的对照研究，以验证蜂蜜对扁桃体切除术后疼痛的改善效果。
临床试验注册号：德国临床试验注册库（German Clinical Trials Register）DRKS00006153。作者确认所有针对该干预措施的正在进行及相关临床试验均已完成注册。