Post-tonsillectomy Pain Relief Research Articles

Ultrasound-guided distal glossopharyngeal nerve block for post-tonsillectomy pain relief in adults: a prospective randomized study.

We aimed to evaluate the safety and efficacy of the novel distal approach of ultrasound (US)-guided glossopharyngeal nerve (GPN) block at the pharyngeal wall for enhancing the quality of analgesia in patients undergoing tonsillectomy. Fifty patients, both male and female, between the ages of 21 and 65, categorized as ASA I-II by the American Society of Anesthesiologists (ASA) and who were scheduled for tonsillectomy, were enrolled in the study. Patients were randomly assigned to receive general anesthesia with either bilateral US-guided distal GPN block (GPN group) or no block (control group). The time for first request of analgesics, postoperative pain scores, the total amount of rescue analgesic medication consumed within a 24-hour period, and the occurrence of any adverse events were all noted. The onset of first analgesic request was significantly prolonged in GPN group than the control group (P=0.013). Pain scores at 30 min, two and six hours postoperative were found to be significantly lower in GPN group than the control group both at rest (adjusted P=0.005, 0.000, and 0.020 respectively) and during swallowing (adjusted P=0.002, 0.000, and 0.015 respectively), with significantly less morphine consumption at 24 hours postoperative in GPN group compared with the control group (P=0.002). No significant postoperative block-related complications were observed. In patients having tonsillectomy, pre-emptive application of US-guided distal GPN block at the pharyngeal wall enhanced the quality of analgesia and decreased the need for rescue analgesics with no major adverse effects.

Absorption and pharmacokinetics of bupivacaine after bilateral topical administration in tonsillar fossae for posttonsillectomy pain relief.

No previous studies have investigated the systemic absorption of bupivacaine when used topically for posttonsillectomy pain. The present study was undertaken to investigate the pharmacokinetics of bupivacaine after administration by a swab in the tonsillar fossae over 4 min after tonsillectomy. Eleven adult patients undergoing elective tonsillectomy were recruited. After removal of both tonsils, each of the two tonsillar fossae was covered with a swab moistened with 2 mL of bupivacaine 5 mg/mL, that is, a total of 20 mg bupivacaine. Blood samples were drawn after 0, 5, 10, 20, 30, 45, and 60 min. Bupivacaine was analyzed with an ultra-high-performance liquid chromatography-tandem mass spectrometry method. The highest single measured bupivacaine serum concentration was 23.2 ng/mL and took place 10 min after drug administration. Mean (±SD) Cmax was 11.4 ± 6.0 ng/mL and mean tmax was 11.3 ± 4.7 min. Mean t1/2 was 31.6 ± 9.3 min. As the toxic concentration threshold has been reported to be in the interval 1500-4500 ng/mL, the concentrations measured were well below 2% of the lowest cited toxic threshold. In conclusion, this study shows that applying 4 mL of bupivacaine 5 mg/mL by a swab in the tonsillar fossae posttonsillectomy yields very low plasma concentrations, suggesting its safe application without any risk of systemic toxic effects.

Posttonsillectomy Pain Relief and Wound Healing by Applying Bismuth Iodoform Paraffin Paste (BIPP) to Dissected Tonsillar Beds.

Introduction Tonsillectomy is one of the most common operations performed by otorhinolaryngology surgeons worldwide; however, the insufficient quality of the postoperative pain management and effective posttonsillectomy pain relief remain a clinical dilemma. Objective To evaluate the efficacy of applying bismuth iodine paraffin paste (BIPP) to the dissected fossa as an adjuvant therapy for a better outcome in terms of posttonsillectomy pain management and due to its wound healing properties. Methods The present is a prospective randomized control pilot study with 44 patients aged > 7 years who underwent tonsillectomy. The patients were divided into two groups: the control group and the group that had BIPP applied to the dissected tonsillar fossa. The visual analogue scale score and the post-onsillectomy percentage of tonsillar fossa epithelization were recorded and evaluated. Results Both subjectively and objectively, there a was statistically significant pain-relieving effect in the BIPP group within the first 5 postoperative days ( p < 0.05). From postoperative day 3 onward, the dissected area of the tonsillar fossa healed significantly faster in the BIPP group compared with the control group, and it became stable on day 14. Conclusion The topical application of BIPP showed a better pain-relieving effect, it was safe, and hastened wound healing after tonsillectomy.

Post Tonsillectomy Pain Relief: Comparative Study between Peritonsillar Infiltration of Bupivicain and Intramuscular Diclofenac

Hospital based study carried out on (40) patients from both sexes, aged (4-26) years,underwent Tonsillectomy by dissection method during the period extend from (June2012 to September 2012). The Patients were divided into two groups- Group A (18)patients: include those with pre-incisional – infiltration of bupivicain with subsequent(spray) post operatively on Tonsils bed at evening and next morning. Group B (22)patients: include those patients with diclofenac intramuscular injection, half hourbefore operation with subsequent doses at evening and next morning. (Result): nodifference in history of post- operative nausea and vomiting regarding the two groups.The mean operative time for group (A) was (28.9) minutes, while the mean operativetime for group (B) was (29.5) minutes. Both groups showed no difference regardingreactionary bleeding (bleeding occurs within 24 hours) or secondary bleeding(Bleeding occurs after 6-8 days due to infection). Group (A) showed low score of painin immediate post-operative time but it was not significant, while group (B) showedlow score of pain in most of the cases at evening, it was significant. No difference inboth groups in the next morning both showed low score of pain. Conclusion:intramuscular diclofenac is more potent as pain relief if compare with Bupivicaininfiltration. Aim of study: To identify the effect of infiltration of bupivicain for posttonsillectomy pain-relief and in compare to intramuscular injection of diclofenac.

To Study the Effect of Pre-incisional Infiltration of Ropivacaine for Post-tonsillectomy Pain Relief

To Study the Effect of Pre-incisional Infiltration of Ropivacaine for Post-tonsillectomy Pain Relief

Comparison between landmark and ultrasound-guided percutaneous peristyloid glossopharyngeal nerve block for post-tonsillectomy pain relief in children: a randomized controlled clinical trial

ABSTRACT Background Glossopharyngeal nerve (GPN) block is a useful treatment option for acute post-tonsillectomy pain. This study aimed to assess safety and efficacy of the landmark (LM) technique versus the ultrasound (US)-guided technique for GPN block in children undergoing tonsillectomy. Methods This double-blinded, parallel-group, randomized trial enrolled 54 children of both genders who were American Society of Anesthesiologists physical status grade I–II and were scheduled for tonsillectomy under general anesthesia. All patients underwent percutaneous peristyloid GPN block. In the LM group, 27 patients were managed by insertion of the needle at midpoint of the line between the mastoid process and angle of the mandible. In the US group, 27 patients were managed with the US-guided technique to locate the styloid process. The outcomes were time to first analgesic requirement, pain in rest and during swallowing, easiness of the technique, time required for the technique performance, recovery time from anesthesia, and anesthetist, surgeon, parent, and staff satisfaction. Results The post-tonsillectomy pain score during rest and swallowing, rescue analgesic request, recovery time from general anesthesia, anesthetist’, surgeon’, staff nurses’, and parents’ satisfactions were comparable between the LM technique and US-guided percutaneous peristyloid GPN block (all p ˃ 0.05). However, the LM technique was significantly easier and required shorter duration than the US-guided technique (p ˂ 0.05). Conclusion In tonsillectomy surgery, both the LM technique and the percutaneous peristyloid US-guided GPN block were safe and effective in reducing postoperative pain. Furthermore, the LM technique was easier and had shorter duration to perform than the US-guided technique.

The effect of honey on post-tonsillectomy pain relief: a randomized clinical trial

ObjectiveThe study aimed to evaluate the effects of honey on the incidence of post-operative pain in patients undergoing tonsillectomy. MethodsThis study is a double-blind and randomized controlled trial design. Twenty-four adult male patients underwent tonsillectomy surgery and were randomized assigned into three groups consist of honey group, placebo group, and control group. All subjects were given standard analgesia and antibiotics, also honey for the honey group and placebo for the placebo group, and only standard post-operative regimens for the control group. This study used silk-cotton tree or kapok tree honey (Ceiba pentandra). Honey was used by gargling every six hours for ten days. Likewise, the same method was applied in the placebo group. Pain scale was assessed for ten days using the Visual Analogue Scale questionnaire, and the frequency of analgesic drugs was recorded on days 1, 2, 4, 7, and 10. ResultHoney group showed significantly higher pain reduction when compared to placebo and control groups, with a significant reduction in the pain scale on day 1, 2, 4, 7 and 10 (p = 0.034; p = 0.003; p < 0.001; p = 0.001; p = 0.001) gradually; Significant differences were also observed in analgesic use, especially on day 2, 4 and 7 (p = 0.028; p = 0.001; p = 0.003). ConclusionsAdministration of Kapok tree honey (C. pentandra) after tonsillectomy might reduce post-operative pain and reduce the need for analgesia. Therefore, honey can be considered a complementary medicine and can be administered routinely as adjunctive therapy for post-operative patients.

Nonpharmacological Management of Posttonsillectomy Pain

Tonsillectomy is a frequently performed surgical procedure by otolaryngologists. Patients' complaints of posttonsillectomy pain are unavoidable. Pain is a significant obstacle for rehabilitation of the patients following tonsillectomy and it influences the duration of the hospital stay and ability to revive for normal activity. The pain following tonsillectomy often affects oral intake, ability to return to their daily world, and discharge from the hospital. The relief of posttonsillectomy pain remains challenging and even controversial. Pain is common and intense in the posttonsillectomy period. Posttonsillectomy is one of the most common unpleasant side effects of tonsillectomy. There are several techniques and treatment methods available to get relief from posttonsillectomy pain. Although this area has received little scientific attention until now, the desire for alternatives to drug-based treatment for posttonsillectomy pain has continued to develop in recent years. Currently, pain following the posttonsillectomy period continues to be a highly debated issue and an area of active research. Throat pain in the posttonsillectomy period can result in significant morbidity among patients. There are different pharmacologic agents available; each one has its risk profile and side effects when used for controlling posttonsillectomy pain. However, here this reviews article discusses important nonpharmacological agents for the management of posttonsillectomy pain. This article reviews the epidemiology, pathophysiology, and details of nonpharmacological agents used for controlling posttonsillectomy pain.

Effect of topical bupivacaine on post-tonsillectomy pain relief in children

Tonsillectomy is a common surgery performed in paediatric otorhinolaryngology and is usually accompanied by considerable postoperative pain. Earlier literature has shown the use of topical bupivacaine for post-tonsillectomy pain relief to be promising. This study was conducted to evaluate the efficacy of topical bupivacaine application on post-tonsillectomy pain relief. Fifty consenting patients scheduled for tonsillectomy that met the inclusion criteria were enrolled in the study and assigned into two groups of 25 patients each. Group B had their tonsillar fossa packed with 0.5% bupivacaine soaked gauze for 5 minutes while Group S had normal saline. Pain intensity was measured at 1, 2, 4, 12 and 24 hours postoperatively, using the Faces Pain Scale- Revised (FPS-R). Mean scores for groups B and S at 1, 2, 4, 8, 12, 24 hours were 1.96±1.17, 2.40±0.82, 2.8±1.0, 2.88±1.17, 3.08±0.99, and 3.04±1.02 and 3.36±1.38, 4.72±1.62, 3.92±1.35, 3.76±1.45, 4.00±1.41, 3.38±0.98 respectively. The difference was significant at 1 and 2 hours only (P≤0.05). Post-tonsillectomy pain was reduced in the first two hours by application of bupivacaine soaked gauze.

Preemptive nebulized ketamine for pain control after tonsillectomy in children: randomized controlled trial

ObjectivesThe administration of ketamine as nebulized inhalation is relatively new and studies on nebulized ketamine are scarce. We aimed to investigate the analgesic efficacy of nebulized ketamine (1 and 2mg.kg−1) administered 30min before general anesthesia in children undergoing elective tonsillectomy in comparison with intravenous ketamine (0.5mg.kg−1) and saline placebo. MethodsOne hundred children aged (7–12) years were randomly allocated in four groups (n=25) receive; Saline Placebo (Group C), Intravenous Ketamine 0.5mg.kg−1 (Group K-IV), Nebulized Ketamine 1mg.kg−1 (Group K-N1) or 2mg.kg−1 (Group K-N2). The primary endpoint was the total consumption of rescue analgesics in the first 24h postoperative. ResultsThe mean time to first request for rescue analgesics was prolonged in K-N1 (400.9±60.5min, 95% CI 375.9–425.87) and K-N2 (455.5±44.6min, 95% CI 437.1–473.9) groups compared with Group K-IV (318.5±86.1min, 95% CI 282.9–354.1) and Group C (68.3±21.9min, 95% CI 59.5–77.1; p<0.001), with a significant difference between K-N1 and K-N2 Groups (p<0.001). The total consumption of IV paracetamol in the first 24h postoperative was reduced in Group K-IV (672.6±272.8mg, 95% CI 559.9–785.2), Group K-N1 (715.6±103.2mg, 95% CI 590.4–840.8) and Group K-N2 (696.6±133.3mg, 95% CI 558.8–834.4) compared with Control Group (1153.8±312.4mg, 95% CI 1024.8–1282.8; p<0.001). With no difference between intravenous and Nebulized Ketamine Groups (p=0.312). Patients in intravenous and Nebulized Ketamine Groups showed lower postoperative VRS scores compared with Group C (p<0.001), no differences between K-IV, K-N1 or K-N2 group and without significant adverse effects. ConclusionPreemptive nebulized ketamine was effective for post-tonsillectomy pain relief. It can be considered as an effective alternative route to IV ketamine.

Comparison of the efficacy of ropivacaine and ropivacaine with dexmeditomidine in post tonsilectomy pain relief after peritonsillar infiltration- A prospective randomized double blind study

Introduction: Post operative pain relief is desired goal after tonsillectomy, infiltration of local anesthetic with or without adjuvant can reduce post tonsillectomy pain. Objective: To compare the postoperative analgesic efficacy and side-effects of peritonsillar-infiltration of ropivacaine with or without dexmeditomidine. Materials and Methods: Sixty patients aged 4-14 years posted for tonsillectomy under GA were randomly assigned in two groups of 30 each. In group R: Inj. ropivacaine (0.5%) 0.2ml/kg and in group RD: Inj.ropivacaine (0.5%) 0.2 ml/kg + Inj. dexmeditomidine 1mcg/kg were infiltrated in peritonsillar fossa post tonsillectomy. Patient were monitored for post-operative pain using VAS score, CHEOPS score and Wong baker pain rating scale at 30 minute, 1hr, 2hr, 4hr, 10 hr, 16hr and 24hr, pain on deglutination, time to first analgesic requirement, total dose of analgesics requirement in 24 hr postoperatively, amount of bleeding and parent’s satisfaction score. Results: VAS score, CHEOPS and Wong baker pain rating scale were comparable in both the groups at 30 min, 1hr, 2hr (P >0.05) but it was significantly low in group RD as compared to group R at 4hr, 10hr, 16hr and 24hr (P Conclusion: We concluded, peritonsillar infiltration of ropivacaine with or without dexmeditomidine is effective method for post-tonsillectomy pain relief. Addition of dexmeditomidine was found to prolong duration, decrease analgesic requirement and improve parent’s satisfaction score. Keywords: Tonsillectomy, Visual analog score, CHEOPS, Wong baker pain rating scale, Ropivacaine and dexmeditomidine.

Peritonsillar morphine infiltration to prevent early postoperative pain after tonsillectomy

Editor,A number of different surgical and medical techniques have been studied in the search for safe and effective post-tonsillectomy pain relief, but the results have been controversial.1 The peripheral administration of opioids has been found to potentially produce analgesia without the systemic

VPLIV TRAMADOLA NA ZDRAVLJENJE POOPERATIVNE BOLEČINE PO ODSTRANITVI ŽRELNICE IN NEBNIC PRI OTROCIH

Background: Tonsillectomy is one of the most commonly performed surgical prcedures in childhood. Acute pain after tonsillectomy and adenoidectomy can be treated with non-opioid and opioid analgesics. Our hypothesis stated that tramadol iv after induction of anaesthesia has superior analgesic effect compared to acetaminophen.Methods: In a prospective, randomised study we compared analgesic efficacy of tramadol (group T: 2 mg/kgBW iv) and acetaminophen (group A: elixir 15 mg/kgBW before op. procedure) in a group of 108 children (age 3-7 years). Exclusion critheria: allergy, liver or kidney failure, epilepsy, febrile convulsions. A standard anaesthetic technique was used: propofol, alfentanil, vecuronium, positive pressure ventilation with 60% nitrous oxide in oxygen. After the procedure each child received acetaminophen suppositories (10 mg/kgBW/4-6h) and combined suppositories. Monitoring: vital signs during and after op. procedure, pain intensity on the ward (facial pain score). Results: There were no significant differences between the two groups in age distribution (mean age 5,2 years), ASA physical status, body weight, operative procedure, pain scores (VAS 6h after operative procedure; group T: 4,21±1,45; group A: 4,06±1,33), oxygen saturation, pulse frequency and the consumption of acetaminophen suppositories. Significant difference was in the consumption of combined suppositories (group T: 1,85±0,79; group A: 1,43±0,69, p=0,003). Conclusion: Our study has shown, that tramadol is not a superior analgesic for the relief of posttonsillectomy pain in children compared to acetaminophen.

Effect of Topical Bupivacaine on Post-Tonsillectomy Pain Relief in Children Referred to Ahvaz Imam Khomeini Hospital in 2013

Background: Tonsillectomy is a common pediatric surgery followed by a severe, sometimes debilitating, postoperative pain. Many drugs can be used to control pain. Objectives: This study aimed to investigate the effects of topical bupivacaine in controlling postoperative pain. Patients and Methods: This clinical trial was performed on 60 elective tonsillectomy patients in Imam Khomeini Hospital, Ahvaz, in 2013. The patients were randomly divided into two groups of A and B; Group A received topical bupivacaine just before the operation, while Group B received placebo (distilled water). The results were statistically analyzed using SPSS-19. Results: Patients aged 4 to 13 years. The amount of postoperative pain was obviously less in the bupivacaine group than the other group. The mean time of postoperative fluid intake was lower in group A (bupivacaine) than Group B (placebo) (P < 0.001). The mean pain score at 24 hours after the operation was lower in the bupivacaine group than the placebo group (P < 0.001). Conclusions: Considering that tonsillectomy is one of the most common surgeries in children and produces a lot of pain, using a low risk medicine such as bupivacaine to recover child as soon as possible seems reasonable.

Honey versus diphenhydramine for post-tonsillectomy pain relief in pediatric cases: a randomized clinical trial.

Tonsillectomy is one of the most common surgeries done worldwide and often the first one a child sustains. Pain relief after tonsillectomy is helpful for oral feeding after surgery. Acetaminophen and diphenhydramine have been conventionally used for reducing pain. This study was conducted to compare the effect of honey and diphehydramine on pain relief after tonsillectomy. For this randomized clinical trial study, 120 patients of 5 to 12 years undergoing tonsillectomy were recruited. The patients were divided into four groups randomly. After tonsillectomy and beginning of eating, Group A took 5cc honey alone every hour, Group B was given 5 cc 50% honey (mixed with water) every hour, group C was treated with 1mg/kg diphenhydramine every 6 hours and group D was observed without any intervention. In all patients, severity of the pain was evaluated by ocher questionnaire at recovery, and 3, 6, 12 and 24 hours after surgery. The data were analyzed using ANOVA and the repeated measures ANOVA (SPSS version 17). The repeated ANOVA showed a significant decreasing trend of pain scores during the study for both pain scales (p <0.05), but the rate of trend was similar between the four groups (p > 0.05). No statistically significant difference in pain was detected among the groups. Although honey can help the pain decrease, more research is supported for confirmation of this effect.

Evaluation of Efficacy of Topical Bupivacaine for Post-Tonsillectomy Pain Relief

Evaluation of Efficacy of Topical Bupivacaine for Post-Tonsillectomy Pain Relief

Does Montelukast Have an Effect on Posttonsillectomy Pain Control in Children?

Objectives: Investigate the efficacy of preemptive montelukast, which is leukotreine receptor blocker for pediatric posttonsillectomy pain management. This is the first time montelucast has been used in posttonsillectomy pain control. Methods: A total of 60 children, aged 5 to 15 years, American Society of Anesthesiologist (ASA) class I-II, scheduled for elective tonsillectomy were enrolled in this double-blinded and controlled study from April of 2013 until January of 2014. The patients were randomized into 2 groups: Montelukast group (Group M, n:30) and control group (Group C, n:30). Group M received 5 mg oral montelukast tablet and Group C received placebo at 24:00 pm the night before surgery. The posttonsillectomy pain was evaluated with Wong-Baker Face Scale during the 24 hours after surgery. Postoperative complications were recorded. The data were analyzed using the Student t test. Data were presented as a mean + SD, and differences were considered significant at P &lt; .05. Results: There were statistically significant differences between Wong-Baker Face Scale scores of the Group C and Group M ( P &lt; .05). The first time, analgesic requirement was higher in group C than in group M ( P &lt; .05).There was no significant difference in demographic parameters and postoperative complications ( P &gt; .05 for both). Conclusions: Preemptive montelukast usage is more effective than the control group in posttonsillectomy pain relief.

Topical bupivacaine compared to bupivacaine infiltration for post-tonsillectomy pain relief in children: a prospective randomized controlled clinical study

The objective of this study is to compare the topical administration of bupivacaine hydrochloride, saline and bupivacaine hydrochloride infiltration on post-tonsillectomy pain in children. Sixty children undergoing tonsillectomy were enrolled in the study. Patients were randomized into three groups using sealed envelopes. Group 1 (n = 20) received topical 0.5 % bupivacaine hydrochloride, group 2 (n = 20) received topical 0.9 % NaCl (saline), and group 3 (n = 20) received 0.5 % bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated using McGrath's face scale. Pain scores in topical bupivacaine hydrochloride group was significantly lesser than the topical saline group at 5th, 13th, 17th and 21st hours, until the 6th day (p < 0.017). Moreover, pain scores of topical bupivacaine hydrochloride group was superior to bupivacaine hydrochloride infiltration group at 5th, 13th, 17th hours and 2nd, 3rd, 4th and 5th day (p < 0.017). There were significantly lesser morbidities in topical bupivacaine hydrochloride than saline group in 1st and 4th day (p < 0.017). Topical administration of bupivacaine hydrochloride proved to provide more efficient pain control than bupivacaine hydrochloride infiltration.

Preemptive peritonsillar infiltration with lidocaine for relief of bipolar adult post-tonsillectomy pain: a randomized, double-blinded clinical study

There are discordant results in the studies of the peritonsillar infiltration in adults undergoing the tonsillectomy. The study is to compare the effect of the preemptive peritonsillar infiltration with lidocaine in bipolar tonsillectomy in adult. 172 adult patients were randomly located into five groups before tonsillectomy: group 0: without the peritonsillar infiltration, group 1: for 3 ml normal saline with 1:200,000 epinephrine per tonsil, group 2: for 3 ml 1 %lidocaine with 1:200,000 epinephrine per tonsil, group 3: for 8 ml normal saline with 1:200,000 epinephrine per tonsil, group 4: for 8 ml lidocaine with 1:200,000 epinephrine per tonsil. The post-operative pain in the following 7 days was assessed by visual analog scale. Operation time and post-operative bleeding were also recorded. No significant differences were found between operative times, post-tonsillectomy hemorrhage between the five groups. The differences between pain scores of the group 0, group 1 and group 2 were not statistically significant (P > 0.05). The differences between pain scores of group 3, group 4 against group 0, group 1, group 2 were statistically significant (P < 0.05). We found the volume of peritonsillar infiltration might contribute to the relief of pain of the bipolar post-tonsillectomy.

Posttonsillectomy pain relief and epithelialization with honey

To assess the ability of honey to reduce pain and promote epithelialization on posttonsillectomy wounds. Materials and methods: A prospective randomized control study was conducted on 60 patients undergoing tonsillectomy from November 2007 to September 2008 at University Malaya Medical Centre. The test group received honey application on the tonsillar bed and the control group had placebo applied. The pain relief was analyzed along with the amount of analgesia consumed, and wound epithelialization was monitored and recorded accordingly. Results: Twenty-one patients from each group were finally analyzed after excluding patients that did not complete the study or fit the criteria. Pain relief and wound epithelialization were observed to be better in the honey-treated group compared to the placebo group. However, the difference was not statistically significant. Conclusion: This study shows that the rate of pain relief and early return to work and school were faster in both groups when compared to the current practice. However, there was no statistical significance seen in either the honey or placebo groups in terms of pain relief and wound epithelization, which could be due to improper choice of placebo. The potential use of honey in wound healing and pain relief should be further explored with more studies.