Impact of Oropharyngeal Packing on Postoperative Nausea, Vomiting, and Throat Discomfort: A Systematic Review and Meta-Analysis.

Background and

Objectives

The insertion of a throat pack is a routine practice during anesthesia in maxillofacial and upper airway surgeries to prevent the aspiration of blood and secretions. However, this technique is associated with postoperative adverse effects such as pharyngitis and nausea. The objective of this systematic review and meta-analysis was to analyze the clinical evidence regarding the effect of throat packs on the incidence of Postoperative Nausea and Vomiting (PONV), throat pain, and gastric volume. Materials and

Methods

Conducted according to PRISMA 2020 and registered in PROSPERO (CRD420251027016), an exhaustive search was performed in PubMed, Scopus, WOS, and Cochrane Library. Randomized Controlled Trials (RCTs) comparing throat pack use versus non-use under general anesthesia were included. Quality was assessed using Cochrane RoB 2. Meta-analyses utilized Standardized Mean Difference (SMD) and Mean Difference (MD) through a random-effects model.

Results

Fourteen articles (2002-2024) involving 1147 patients were included. Methodological quality predominantly raised "some concerns", with only 7.1% of studies assessed at low risk of bias. Statistical analysis of pain intensity (k = 6) revealed a significant increase in the intervention group (SMD = 0.35; 95% CI: 0.09 to 0.62; p = 0.01). Regarding PONV (k = 3), no statistically significant differences were observed between groups (SMD = -0.47; 95% CI: -1.51 to 0.58; p = 0.38). Ultrasound measurements showed significant increases in gastric parameters in the throat pack group, including anteroposterior diameter (MD = -3.67 mm; p = 0.002) and antral cross-sectional area (MD = -223.10 mm2; p = 0.005).

Conclusions

Current evidence does not demonstrate a clear benefit for the routine use of oropharyngeal packing in maxillofacial and upper airway surgeries, and suggests a possible increase in postoperative throat discomfort. While acknowledging the limited number of studies, clinical heterogeneity, and the influence of perioperative co-interventions, these results should be interpreted with caution.