Post-tonsillectomy Pain Research Articles

Intraoperative ice pack application for uvulopalatoplasty pain reduction: A randomized controlled trial

Pain after uvulopalatoplasty continues to cause patients significant morbidity, especially from the tonsillectomy portion. The literature describes multiple techniques to reduce post-tonsillectomy pain, none being definitive. The purpose of this study was to evaluate the effect of intraoperative ice pack application on post-uvulopalatoplasty pain. Single-blinded, randomized controlled trial. After inclusion and exclusion criteria were met, patients were enrolled and randomized, and subsequently underwent standard electrocautery uvulopalatoplasty. Packs were placed into the tonsillar fossae immediately following tonsil removal and into the palate after the palatoplasty. Patients then completed a questionnaire that evaluated their experience for 10 days following surgery. The primary outcome was pain rated on a visual analog scale. Return to work and return to normal diet were also assessed. T test and Mann-Whitney statistical analyses, as well as routine descriptive statistics, were conducted. Eighteen subjects were recruited. Patients that received intraoperative cold packs experienced a statistically significant change in VAS average pain [3.4 ± 1.1 cm (p = 0.00001)] when compared with patients receiving room temperature packs. No difference in return to work (p = 0.16) and return to normal diet (p = 0.12) was identified. Intraoperative ice pack administration results in significantly reduced pain following electrocautery uvulopalatoplasty.

Post-tonsillectomy pain and vomiting:role of pre-operative steroids.

To evaluate the effects of a single pre-operative dose of dexamethasone with the frequency of postoperative vomiting and severity of throat pain in children undergoing electrocautery tonsillectomy under standard general anaesthesia. Randomised controlled trial. ENT Department, Combined Military Hospital, Kharian, from January to December 2010. Children of either gender aged between 4 - 12 years, undergoing tonsillectomy were divided into two groups of 50 each. One group was selected to receive dexamethasone 0.5 mg/kg (maximum of 8 mg); the second group was given equivalent volume of saline, pre-operatively. The frequency of early and late vomiting was assessed postextubation. Mean time of first oral intake in minutes after extubation and mean score of postoperative throat pain were compared in both groups. Severity of throat pain was monitored by Visual Analogue Scale (VAS) score 0-10 after 4,8,12 and 24 hours of extubation. Dexamethasone group showed significantly less postoperative early vomiting (12%, n = 6) as compared to placebo (30%, n = 15) group (p < 0.05). The mean time of first oral intake was earlier in the dexamethasone group (4 hours and 16 minutes postextubation), while in saline group it was 5 hours and 20 minutes (p < 0.001). Pain score was also significantly lower and swallowing was less painful in patients after 4,8,12 and 24 hours in dexamethasone group. Pain score on the average was 0.8 - 1.2 factors less in dexamethasone group than in saline group in first 24 hours on a VAS score of 1 -10. Pre-operative intravenous dexamethasone reduced postoperative vomiting and pain significantly in children undergoing electrocautery tonsillectomy.

Effect of perioperative administration of parecoxib on post-tonsillectomy pain in adults

Post-tonsillectomy pain is one of the most difficult pain states to manage in otolaryngology. In this study, we investigated the analgesic effect of parecoxib in adults undergoing tonsillectomy. Eighty-eight patients that underwent tonsillectomy were randomly allocated to two groups to receive either intravenous 80 mg 24 h-1 parecoxib (group P) or saline as control (group C) at two medical center of university. Anesthesia was induced using intravenous sufentanil and propofol, while endotracheal intubation was facilitated with rocuronium and maintenance was accomplished using sevoflurane. Pain scores, the rescue analgesic consumption, the frequency of postoperative complications including bleeding, nausea and vomiting and other major event were recorded 1, 2, 4, 12 and 24 h after the operation. P<0.05 was considered statistically signii¬cant. In total, 80 patients successfully completed the study. Intravenous parecoxib (40 mg Bid), significantly reduced pain intensity both at rest and during swallowing in the first 24 h after tonsillectomy. The median pain score was reduced from moderate (4.5) to light pain (3) at rest and from severe pain (6.5) to moderated pain (4-5) during swallowing. Forty-four (43%) patients received paracetamol in the ward [22 (55%) in the control group and 12 (30%) in the parecoxib group; P<0.05]. Re-operation for bleeding, postoperative nausea and vomiting (PONV) and other major adverse events were not different between groups. In conclusion, perioperative administration of parecoxib (40 mg, Bid) was effective for postoperative pain at rest relief in adults undergoing tonsillectomy. Key words: Tonsillectomy, pain, parecoxib, analgesia.

The effect of paracetamol, metamizole sodium and ibuprofen on postoperative hemorrhage following pediatric tonsillectomy

ObjectiveTo determine the risk of postoperative hemorrhage associated with the use of analgesic drugs including paracetamol, metamizole sodium and ibuprofen after pediatric tonsillectomy. Patients and methodsThree hundred and forty consecutive children with recurrent tonsillitis and/or obstructive symptoms were included in the study. Children were divided into three groups based on the drugs used for postoperative pain relief. Each group received paracetamol, metamizole sodium and ibuprofen following the surgery. The study of population was compared respect to postoperative bleeding. Chi-square test was used for statistical analysis. ResultsA total of 115 patients received ibuprofen, 115 patients were given metamizole sodium and 110 patients were given paracetamol. Posttonsillectomy hemorrhage occurred in fourteen (4.11%) children, consisting of primary hemorrhage in two patients and secondary hemorrhage in twelve patients. While 6 of 115 children (5.21%) who were given ibuprofen had postoperative hemorrhage, 4 of 115 children (3.47%) in metamizole sodium group and 4 of 110 patients (3.63%) in paracetamol group had hemorrhage. There was no significant difference with respect to hemorrhage rates between these three groups (p<0.05). ConclusionIn our study we could not show significant risk of hemorrhage after using of ibuprofen, metamizole sodium and paracetamol administration and they can be used safely for posttonsillectomy pain.

Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial

AimTo assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects.MethodsThe double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery.ResultsTramadol group had significantly lower pain scores (P = 0.005), significantly longer time to the first request for analgesic (P = 0.001), significantly shorter time to the beginning of liquid regimen (P = 0.001), and lower hemodynamic parameters such as blood pressure (P = 0.001) and heart rate (P = 0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting.ConclusionPreoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects.Registration No: IRCT201103255764N2

Comparison of post-tonsillectomy pain with two different types of bipolar forceps: Low temperature quantum molecular resonance device versus high temperature conventional electrocautery

Conclusion: The low temperature device did not show any advantages over the conventional high temperature electrocautery in terms of the postoperative pain, operation time, and complications in pediatric tonsillectomy. Objective: To compare post-tonsillectomy pain following the use of two different instruments with the same bipolar forceps techniques: low temperature quantum molecular resonance (QMR) device versus conventional high temperature electrocautery. Methods: Pediatric patients admitted from July 2008 through January 2009 were included. The participants underwent bilateral tonsillectomy; one side by the QMR device and the other by the bipolar electrocautery. The sides for each instrument were counterbalanced by the order of presentation. The postoperative pain was measured using the faces pain rating scale. Results: In all, 33 patients with a mean age of 7.6 years were enrolled. The postoperative pain, operation time, and complications in 33 sides dissected by the electrocautery and 33 sides by the QMR device were compared. The average operation times with each device were not statistically different. The mean ratings of the perception of pain related to each instrument were not different on operation day and postoperative day 1, day 4, and day 7 (p = 0.133, 0.057, 0.625, and 1.0, respectively). There was no postoperative complication in any of the patients.

EMG Assessment of Analgesia in Treatment of Posttonsillectomy Pain

Surface electromyographic (sEMG) study of posttonsillectomy swallow-evoked muscular reactions was performed to assess validity of EMG in evaluation of analgesic drugs. Sixty randomly chosen operated adults were divided into group 1 (n=30) treated with oxycodone, and group 2 (n=30) treated with placebo. Pain assessment included visual analog scale (VAS) pain score and EMG data: the timing, electric amplitude, and graphic patterns of muscular activity. We investigated masseter, infrahyoid, and submental-submandibular muscles. Records from trapezius muscle were used for control. The results were compared with previously established normative database. The sEMG data were compared with VAS score. Oxycodone significantly reduced VAS pain score and changed muscle reactions to analgesia (amplitude) as was recorded by sEMG, whereas placebo reduced VAS pain score nonsignificantly and changed the reaction of the trapezius muscle only. Analgesia smoothes the recorded swallow peaks and increases time of deglutition. Statistically significant difference in muscle reactions was detected between the 2 groups. sEMG might be used for quantitative evaluation of analgesic drugs by assessment of muscular reactions to pain and to analgesia. This method might add quantitative justification to the information obtained by VAS pain testing and clinical data.

Evaluation of a Low Dose Ketamine in Post Tonsillectomy Pain Relief: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine in Pediatrics

BackgroundPain control in children is still a therapeutic dilemma. Preschool patients are affected from undesirable effects of postoperative pain more than adults. Tonsillectomy is associated with a high incidence of postoperative pain, not only complicating the recovery, but also delaying patients discharge.ObjectivesDespite employing different surgical and anesthetic strategies in post-tonsillectomy pain relief, this is still a clinical problem. The study was designed to evaluate the efficacy of a low dose ketamine in post tonsillectomy pain relief.Patients and MethodsOur prospective randomized double blinded study enrolled 75 pediatric patients (3-10 years old) who were scheduled for a tonsillectomy procedure. Patients were randomly assigned to one of three groups receiving; intravenous (IV) ketamine 0.5mg/kg, subcutaneous (SC) ketamine 0.5 mg/kg and placebo at the end of the operation. Post-operative pain score was assessed using modified CHEOPS.ResultsIn our study we did not find any significant difference among the three groups regarding sex, age, and weight, duration of operation, hemodynamic stability, and nausea and vomiting. However, in ketamine groups, pain score and analgesic consumption were significantly lower (P < 0.00). The efficacy of the both ketamine groups was similar.ConclusionsThe study demonstrated that the both subcutaneous and intravenous injections of ketamine, at the end of the operation, were safe and effective for post-tonsillectomy pain control. Ketamine reduced postoperative analgesic medications consumption without increasing the risk of complications.

The effect of ketamine on posttonsillectomy pain in children: a clinical trial.

Tonsillectomy is one of the most common surgical operations and has such complications as pain, hemorrhage and laryngospasm. Pain management is of vital importance in order to reduce the suffering and restlessness in children having undergone tonsillectomy. Different studies differ in their findings as to the use of ketamine for postoperative analgesia. The aim of this study was to investigate the effect of peritonsillar injection of ketamine preoperatively on postoperative pain relief. This was a randomized controlled trial (RCT) on sixty 3-12-year-old children. Children were randomly assigned to the intervention and control groups. Peritonsillar injection consisted of 1 mg/kg ketamine in the intervention group and of normal saline in the control group. An injection of 1 cc was administered on each side five minutes prior to tonsillectomy. Pain assessment was performed using the self-report Oucher Scale and CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) and sedative state assessment was performed using the Wilson Sedation Scale. Pain, medication and complications were studied for 24 hours. Data analysis was performed using chi-squared test and t-test. The ketamine group had a lower pain score compared with the control group (1.40±1.003 compared with 1.53±1.074). The average pain was less in the control group two hours after the surgery. The difference was statistically significant. There was no difference between the two groups in terms of nausea and vomiting incidence. The peritonsillar injection of ketamine five minutes prior to the surgery reduces the post-tonsillectomy pain without causing any complications.

Comparison Between Effect of Lidocaine, Morphine and Ketamine Spray on Post-Tonsillectomy Pain in Children

BackgroundAn effective pain therapy to block or modify the physiological responses to stress has become an essential component of modern pediatric anesthesia and surgical practice.ObjectivesThe goal of this study was to compare the analgesic effects of the spray forms of; lidocaine, morphine, ketamine, and normal saline on post-tonsillectomy pain scores in children.Patients and MethodsA total of 120 children, American Society of Anesthesiologist (ASA) class I–II, scheduled for elective tonsillectomy were enrolled in this double-blind, clinical trial study. They were randomly divided into 4 groups, each receiving one of the following drugs at the end of operation; lidocaine spray (2 mg/kg); morphine spray (0.05 mg/kg); ketamine spray (0.5 mg/kg); or normal saline spray (8 puffs). For comparison of postoperative pain; the face, legs, activity, cry, consolability (FLACC) pain scale was evaluated during the first one hour of recovery period at 20 minutes intervals. The data was transferred to SPSS-10 software and analyzed statistically with the Scheffe test and Dunnett’s T3 test. P value less than 0.05 was considered significant.ResultsIn the early postoperative period (time: 0) and at 20, 40 and 60 minutes of recovery time, FLACC scale scores in the control group were higher than in the three other groups. At 20 minutes, the FLACC scale score in the lidocaine group was lower than in the other groups. At 40 minutes, the statistical differences between FLACC scales of the lidocaine, morphine and ketamine groups were not significant (P > 0.05). Finally, at 60 minutes, the FLACC scale scores of the ketamine and morphine groups were lower than in the other groups.ConclusionsThe results of this study showed that lidocaine spray had the best pain controlling effect at 20 minutes in the recovery room, but after 40 minutes, ketamine and morphine sprays were more effective than the lidocaine spray.

Assessing Intravenous Ketamine and Intravenous Dexamethasone Separately and in Combination for Early Oral Intake, Vomiting and Postoperative Pain Relief in Children Following Tonsillectomy

The aim of the present study is to evaluate the effect of preoperative 0.5 mg/kg i.v. dexamethasone in combination with 0.5 mg/kg i.v. ketamine on pain, early oral intake and vomiting in pediatric patients undergoing tonsillectomy during the first 24 hours of the postoperative period. One hundred twenty children who were scheduled for tonsillectomy were randomly assigned to receive a single dose of dexamethasone 0.5 mg/kg i.v. as Group D (n = 30), receive ketamine 0.5 mg/kg i.v. as Group K (n = 30), receive dexamethasone 0.5 mg/kg i.v. and ketamine 0.5 mg/kg i.v. as Group KD (n = 30) and an equivalent volume of saline as Group C (n = 30) 15 minutes before the induction of anesthesia. Post-operative pain was evaluated using an observational pain score (OPS) on arrival to the post-anesthesia care unit (PACU), at 15, 30, 45, and 60 minutes after that and at 1, 2, 4, 6, 12, and 24 hours after arrival to the ward. OPS scores were significantly lower at the time of arrival to the PACU, and at 15, 30, 45, and 60 minutes in the Group KD compared with Group C (p < 0.05). Postoperative OPS scores were significantly lower at 1, 2, 4, 6, 12, and 24 hours after operation in Group KD compared with Group C (p < 0.05). A prophylactic preoperative single dose of i.v. 0.5 mg/kg dexamethasone in combination with a single dose of i.v. 0.5 mg/kg ketamine significantly decreased post-tonsillectomy pain compare with using i.v. ketamine or i.v. dexamehasone separately.

Dexamethasone reduces pain, vomiting and overall complications following tonsillectomy in adults: a systematic review and meta‐analysis of randomised controlled trials

Tonsillectomy is one of the most common surgical procedures, but there is debate whether systemic steroids should be used to reduce pain and post-operative complications. To determine whether peri-operative steroids reduce post-tonsillectomy pain and complications in adults. Systematic review and meta-analysis of randomised controlled trials. We searched MEDLINE (1950-2010), EMBASE (1980-2010), CINAHL (1981-2010), Web of Science, ProQuest, metaRegister, Conference Proceedings Citation Index, the Cochrane Library and reference lists of relevant studies. Two reviewers independently selected trials and extracted data on their quality, characteristics and results. Trials included adults (age >16 years) undergoing elective tonsillectomy where peri-operative steroids were used, and the results were compared with control or placebo. There were seven randomised controlled trials (580 patients) reporting post-operative pain. Meta-analysis demonstrates that dexamethasone in adults reduces the pain level experienced in the first post-tonsillectomy day [standard mean difference (SMD): -0.63, 95% CI: -1.13 to -0.12] with significant heterogeneity (I(2) = 84%, P < 0.00001). Sub-group analysis to explore heterogeneity demonstrated this reduction in pain was mostly with high total dose steroids (total >10 mg over first 24 h post-operatively; SMD: -1.48, 95% CI: -2.17 to -0.79, P < 0.00001), especially when given both intra-operatively and post-operatively. There was no significant effect with low doses (SMD: -0.12, 95% CI: -0.36 to 0.13, P = 0.35). There were three trials (231 patients) that reported post-operative nausea and vomiting, three other trials (270 patients) reporting on bleeding and three trials (401 patients) reporting other complications (infections and odynophagia). There was a significant reduction in post-operative nausea and vomiting (RR: 0.53, 95% CI: 0.36 to 0.80, P = 0.002, I(2) = 26%) and bleeding (RR: 0.45, 95% CI: 0.25 to 0.80, P = 0.007, I(2) = 0%), but the reduction in the other complications did not reach statistical significance (RR: 0.69, 95% CI: 0.48 to 1.01, P = 0.06, I(2) = 0%). Pooling of these complications (post-operative nausea and vomiting, bleeding, infections and odynophagia) shows that in six trials (501 patients), the use of dexamethasone significantly reduced post-operative complications following tonsillectomy in adults (RR: 0.59, 95% CI: 0.49 to 0.71, P < 0.00001, I(2) = 0%), when compared with placebo or control. Dexamethasone reduces pain, post-operative nausea and vomiting, bleeding and overall post-operative complications in adults undergoing tonsillectomy. However, the effect of the dose of dexamethasone on post-operative pain and whether dexamethasone reduces bleeding require further research.

The Efficiacy of Anterior and Posterior Archs Suturation at Inferior Tonsillar Pole for Posttonsillectomy Pain Control

The aim of our study was to investigate the efficiacy of the suturation technique after completing the tonsillectomy procedure for posttonsillectomy pain control in adult patients. August 2010-February 2011, 44 adult patients, ages ranged from 16 to 41years old who underwent tonsillectomy at Elaziğ Training and Research Hospital Otorhinolaryngology Clinic were included to the study. After tonsillectomy procedure, anterior and posterior tonsillar archs were sutured each other and so, the area of tonsillectomy lodges which covered with mucosa were increased. Twenty two patients who applied posttonsillectomy suturation were used as study group and remnant 22 patients who did not applied posttonsillectomy suturation were used as control group. The visual analogue score (VAS) was used to evaluate the postoperative pain degree (0 no pain, 10 worst pain). ANOVA test (two ways classification with repeated measures) was used for statistical analysis of VAS values. P<0.05 was accepted as statistically significant. The effect of time (each post-operative day) on VAS values was significant. The mean VAS values between study and control group on post-operative day 1st, 3rd, 7th, and 10th were statistically significant (P<0.05). The severity of posttonsillectomy pain was less in study group patients than control group patients. The suturation of anterior and posterior tonsillar archs after tonsillectomy procedure was found effective to alleviate the posttonsillectomy pain in adult patients.

편도 적출술시 섬유소 응고제(Tachocomb®)이통증 조절에 미치는 영향

편도 적출술시 섬유소 응고제(Tachocomb®)이통증 조절에 미치는 영향

Efficacy and safety of intraoperative dexmedetomidine in pediatric posttonsillectomy pain: Peritonsillar versus intravenous administration

BackgroundAlthough being used off-label, the utility of dexmedetomidine in pediatric settings is increasing. Alpha-2 agonists have peripheral analgesic effects. This prospective, randomized, double-blind, Placebo-controlled study was designed to evaluate the safety and efficacy of dexmedetomidine single intraoperative preincisional dose in pediatric patients undergoing tonsillectomy and adenoidectomy.Patients and methodsEighty-four children (5–12 years) were randomized into three groups: DEX.IV (n = 28) received dexmedetomidine 1 μg/kg iv. infusion in 10 min, DEX.PT (n = 28) received dexmedetomidine 1 μg/kg peritonsillar infiltration, and the Placebo controls (n = 28). Assessment parameters included pain, sedation, hemodynamics, and adverse effects.ResultsIntraoperative dexmedetomidine administration resulted in a significant reduction in pain scores postoperatively in the DEX.IV and DEX.PT groups, with no significant difference between them. The time to first postoperative analgesic request was significantly prolonged in DEX.IV (583.45 ± 157.94 min, P < 0.000) and DEX.PT (537.61 ± 106.17 min, P < 0.000) groups compared with the Placebo group (119.75 ± 43.44 min). Similarly, a significantly lower paracetamol consumption during the first postoperative day was recorded in the DEX.IV (459.37 ± 114.82 mg, P < 0.000) and DEX.PT (475.38 ± 143.11 mg, P < 0.000) groups, than in the Placebo group (705.00 ± 249.27 mg), with no significant difference between DEX.IV and DEX.PT groups. Patients in the DEX.IV group exhibited significantly prolonged extubation times ((13.83 ± 3.38 min, P < 0.000) and significantly higher mean Ramsay sedation scores at 15, 30, 60, 120, and 180 min postoperative (P < 0.000), compared with DEX.PT and Placebo groups. The mean intraoperative heart rates were significantly slower in DEX.IV group during and after the intravenous infusion of dexmedetomidine and at 15th min intraoperative (p < 0.05), compared with DEX.PT and Placebo groups, with no significant differences in mean heart rates among the groups in other time points measured. Patients in DEX.PT group had a significantly higher total oral intake in first day postoperative (P < 0.000) and a significantly higher family satisfaction (p < 0.000), compared with DEX.IV and Placebo groups.ConclusionPeritonsillar infiltration or iv. dexmedetomidine similarly enhanced the postoperative analgesia after tonsillectomy in pediatric patients. However, locally applied dexmedetomidine was associated with no systemic effects, higher total oral intake in first day postoperative, and higher family satisfaction.

Effects of Levobupivacaine versus Bupivacaine Infiltration on Postoperative Analgesia in Pediatric Tonsillectomy Patients: A Randomized, Double-Blind, Placebo-Controlled Study

We compared the effects of levobupivacaine hydrochloride, bupivacaine hydrochloride, and saline injections in alleviating posttonsillectomy pain. Between November 2009 and April 2010, we recruited 60 patients (36 male and 24 female) between 2 and 12 years of age into the study. After informed consent was obtained from the parents, patients admitted for tonsillectomy were randomized into 3 groups by means of sealed envelopes. Group 1 (20 patients; mean age, 6.45+/-2.78 years) received 0.9% sodium chloride (saline solution), group 2 (20 patients; mean age, 5.60+/-2.70 years) received 0.25% levobupivacaine hydrochloride, and group 3 (20 patients; mean age, 5.85+/-2.43 years) received 0.5% bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated with McGrath's face scale. The postoperative pain scores at 1 and 5 hours were similar among the groups (p>0.05). The pain scores in the levobupivacaine group were lower than those in the saline group at 13 hours (p<0.017). The pain scores in the bupivacaine and levobupivacaine groups were significantly lower than those in the saline group from 17 to 21 hours until day 6 (p>0.017). There was no difference between the levobupivacaine and bupivacaine groups (p>0.017). Local infiltration of levobupivacaine is a relatively safe and effective method and is equivalent to use of bupivacaine for posttonsillectomy pain.

Electromyographic Assessment of Dexamethasone in Treatment of Post-Tonsillectomy Pain: Randomized, Placebo-Controlled Trial

IntroductionSurface electromyographic (sEMG) study of post-tonsillectomy swallow-evoked muscular reactions was performed to assess analgesic properties of dexamethasone. MethodsSixty randomly chosen operated adults were divided into 2 groups. Group 1 (n=30) was treated with dexamethasone (Dexacort, 20mg); group 2 (n=30) was treated with placebo. Pain assessment included visual analogue scale (VAS) pain score and the EMG data such as the timing, electric amplitude and graphic patterns of muscular activity during deglutition. We investigated masseter, infrahyoid and submental-submandibular muscles. Records from trapezius muscle were used for control. The results were compared with previously established normative database. The sEMG data were compared with VAS pain score with regard to changes in clinical condition of the patients. ResultsSurface EMG signs of analgesia after tonsillectomy did not always correspond with the VAS pain score. Dexamethasone normalizes muscular activity in deglutition as detected by the EMG records. Statistically significant difference in muscle reactions was detected between the 2 groups. ConclusionIf dexamethasone is administered, the reduction of the postoperative pain could be secondary to the reduction of edema. The sEMG might be used for quantitative evaluation of analgesics via assessment of neuromuscular reactions to analgesia.

Pregabalin and dexamethasone improves post-operative pain treatment after tonsillectomy

Post-tonsillectomy pain can be severe. We investigated the analgesic effect from combinations of paracetamol, pregabalin and dexamethasone in adults undergoing tonsillectomy. In this randomized double-blind study, 131 patients were assigned to either group A (paracetamol+placebo), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). Pre-operatively, patients received either paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg or placebo according to their allocation. Post-operative pain treatment included paracetamol 1000 mg 4× and ketobemidone 2.5 mg p.n. Ketobemidone consumption, pain scores [visual analogue scale (VAS)], nausea, sedation, dizziness, number of vomits and consumption of ondansetron were recorded 2, 4 and 24 h after the operation. P<0.05 was considered statistically significant. The mean 24-h VAS-pain score at rest was reduced in group C (P<0.003) vs. group A. The mean 24-h VAS-pain scores during swallowing were reduced in group B (P=0.009) and group C (P<0.003) vs. group A. Consumption of ketobemidone (1-4 h post-operatively) was lower in group B (P=0.003) and group C (P=0.003) vs. group A. The mean 24-h dizziness score was higher in group B (P<0.003) and C (P=0.003) vs. group A. Other parameters including re-operation for post-tonsillectomy bleeding were not different between groups. Pregabalin and pregabalin+dexamethasone reduced post-operative pain scores and consumption of ketobemidone following tonsillectomy. Dizziness was increased with pregabalin.

Comparison of peritonsillar levobupivacaine and bupivacaine infiltration for post-tonsillectomy pain relief in children: Placebo-controlled clinical study

Objectives To compare the effects of preincisional peritonsillar infiltration of levobupivacaine and bupivacaine on post-tonsillectomy pain in children. Methods Sixty children undergoing elective tonsillectomy or adenotonsillectomy were randomly allocated into three groups before tonsillectomy: peritonsillar infiltrations with 0.25% levobupivacaine with 1:200,000 epinephrine (group levobupivacaine, n = 20), 0.25% bupivacaine with 1:200,000 epinephrine (group bupivacaine, n = 20), and normal saline (group saline, n = 20) were applied. Pain was evaluated by using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS). Choice of additional analgesic was acetaminophen for all patients. Results mCHEOPS values at 0th (immediately) and 30th minute after arrival the PACU were lower in both the local anesthetics groups than the saline group ( p < 0.001, p < 0.01 for the group levobupivacaine; p < 0.001, p < 0.05 for the group bupivacaine, respectively). In addition, mCHEOPS values at 1st hour in the ward was lower in the group bupivacaine when compared to the group saline ( p < 0.05). Analgesic requirements and the time to first analgesia required, were also significantly different between the local anesthetic and saline groups ( p < 0.05 for both local anesthetics groups). Time to first mobilization was shorter in both local anesthetic groups when compared to the saline group ( p < 0.05 for both local anesthetic groups). Conclusion Preincisional peritonsillar infiltration with levobupivacaine or bupivacaine before tonsillectomy, are effective than saline, in reducing early post-tonsillectomy pain, where as bupivacaine had slightly longer effect. Compared to saline, with both anesthetic infiltrations, lesser medication for analgesia is required. The clinical trial registration number (Research Ethics Committee of Medical Faculty, Uludag University): 2008-4/36, 19 February 2008.

Topical bupivacaine compared to lidocaine with epinephrine for post-tonsillectomy pain relief in children: A randomized controlled study

Objective To compare the topical administration of bupivacaine hydrochloride, lidocaine hydrochloride with epinephrine and saline in alleviating post tonsillectomy pain. Study design A double-blind prospective randomized controlled clinical study. Methods Between November 2008 and March 2009, 60 patients (32 males and 28 females) between ages of 1.5 and 15 years were recruited into the study. After informed consent was obtained from the parents, patients, admitted for tonsillectomy, were randomized into three groups using sealed envelops. Group 1 (20 patients, mean age 5.2 ± 1.7) received topical lidocaine hydrochloride (20 mg/ml) with 0.00125% epinephrine. Group 2 (20 patients, mean age 6 ± 3.7) received topical 0.5% bupivacaine hydrochloride and group 3 (20 patients, mean age 6.7 ± 3.6) received topical saline. Results The post-operative pain scores at 1 h were similar among the groups ( p = 0.29). Pain scores in bupivacaine hydrochloride group were significantly lesser than the saline group at 5th, 13th, 17th and 21st hours, until the sixth day ( p < 0.017). Moreover, pain scores of bupivacaine hydrochloride group were superior to lidocaine hydrochloride group starting at 17 h, until fourth day ( p < 0.017). Pain scores of lidocaine hydrochloride group were lesser than saline group in the first and fifth days ( p < 0.017), whereas, there was no significant difference at other times. Conclusion Topical administration of bupivacaine hydrochloride proved to provide more efficient pain control than both saline and lidocaine without any drug related complication.