Post-tonsillectomy Pain Research Articles

Is ketamine effective in posttonsillectomy pain in children?

Is ketamine effective in posttonsillectomy pain in children?

Ketamine in post-tonsillectomy pain

There has yet been no ideal method for postoperative analgesia in children. Ketamine demonstrates a potent analgesic effect by central blockage of perception of pain with sub-anesthetic doses. Preoperative intramuscular administration of ketamine for sedation decreases the pain during swallowing after tonsillectomy, while it provides long-term analgesia when applied around the incision. The aim of this study is to compare the effectiveness of ketamine administered to the tonsillar region following tonsillectomy for postoperative pain management. After obtaining consent from the local ethics committee and the parents, 60 patients from the ASA groups I and II, between 3 and 7 years of age, planned for adenotonsillectomy as outpatients, were included in the study. Subjects were randomly assigned to two equal groups and 2ml 0.9% saline for group S, and 0.5mgkg(-1) ketamine and saline 2ml in volume for group K were administered into the tonsillar region. All subjects were monitored in a standard manner and SpO(2), systolic arterial pressure (SAP), and cardiac pulse rates were recorded in 5min intervals. The CHEOPS and Wilson sedation scale were used to evaluate pain levels and sedative condition, respectively. Nausea and vomiting scores of the subjects were also noted. The time of the first analgesic administration and the total amount of analgesics in an 8-hour period were recorded. Student-T and Chi-Square tests were used for the statistical evaluation of the data and a p value of <0.05 was accepted as significant. There were no significant differences between groups according to age, sex, weight, intermittent SAP and cardiac pulse rates. However, the CHEOPS value, the first analgesic need and the total amount of analgesic need were in favor of ketamine (p<0.05). In previous studies, no significant differences were demonstrated in pre-emptive analgesia with ketamine, magnesium, morphine, and clonidine. The dose of ketamin and the volume used in this study caused no sedation or nausea and provided a high level of analgesia. Ketamine infiltration into the tonsillar region after tonsillectomy was found to be easy and effective.

Evaluation of Local Injection of 0.5% Bupivacaine + 1/200000 Epinephrine for Post Tonsillectomy Pain Reduction

To determine the effectiveness of postoperative local infiltration of Bupivacaine in decreasing post tonsillectomy pain. A double blind randomized clinical trail was conducted. Treatment group was administered 3-10 ml 0.5% Bupivacaine + 1/200000 Epinephrine solution and control group was received 3-10 ml normal saline, locally. Outcome was post surgical pain, which measured by visual analogue scale (VAS), after 6, 12, 18 hours post surgical. The mean scores of pain after surgery were lower grade in treatment group than placebo group. Post tonsillectomy pain suffered patients and required to reduce; hence pharmacotherapy seems necessary for it. Current finding was shown local 0.5% Bupivacaine + 1/200000 Epinephrine injection is good for pain relief.

Comparative Study of Acetaminophen-Morphine versus Rofecoxib-Morphine for Post-Tonsillectomy Pain Control

Although we routinely use morphine at our institution, moderate to severe pain often persists for several days after tonsillectomy. Nonsteroidal anti-inflammatory drugs could offer significant relief. Unfortunately, concerns about increased risk of bleeding limit their use. Selective inhibitors of cyclooxygenase type 2 (COX-2), such as rofecoxib, which do not affect bleeding time, could be an interesting option. To evaluate the efficiency and safety of "rofecoxib-morphine" versus "acetaminophen-morphine" for post-tonsillectomy pain control. Eighty children (5-17 years old) took part in this prospective comparative study. Forty children were in the acetaminophen-morphine group (group A), and the remaining 40 children were in the rofecoxib-morphine group (group R). Pain scores, administered doses of medication, side effects, and the general health status of the child were collected by telephone calls made on the first, third, and seventh days after surgery. Pain scores for group A compared with group R are as follows: day 0 at home arrival, 4.6 to 2.5; day 0 average, 4.7 to 3.3; day 1, 3.6 to 2.6; day 3, 2.3 to 1.4; and day 7, 1.4 to 2.0. Moreover, children who received rofecoxib generally drank, ate, and returned to their regular activities more quickly than the children of group A. No side effects were reported with rofecoxib. Rofecoxib (COX-2 inhibitor) significantly reduces pain scores after pediatric tonsillectomy. The combination of rofecoxib and morphine is safe and helps children return more quickly to their activities.

Comparison of Posttonsillectomy Pain Using the Ultrasonic Scalpel, Coblator, and Electrocautery

Comparison of Posttonsillectomy Pain Using the Ultrasonic Scalpel, Coblator, and Electrocautery

Role of Bupivacaine in reducing post tonsillectomy pain.

Pain following tonsilleclomy is of major concern to both the surgeons and the Anesthesiologists. Pre-incisional Bupivacaine infiltration into the tonsillar fossa has been used as a method of relieving post-operative pain in children. In this study pre-incisional Bupivacaine infiltration into the tonsillar fossa resulted in immediate post-operative pain lasting four to six hours.

Single-Blind Evaluation of Post-Tonsillectomy Pain Treatment with an Eutectic Mixture of Local Anesthetics

The efficacy of an eutectic mixture of local anesthetics (lidocaine and prilocaine) in ointment for topical use (EMLA) in the treatment of post-tonsillectomy pain in both pediatric and adult patients was evaluated. Ninety patients affected by recurring tonsillitis and refractory to antibiotic therapy were submitted to tonsillectomy by dissection. Of the ninety patients 45 random subjects received topical treatment and the remaining 45 did not receive any treatment in the emptied tonsillar compartment. Pain intensity was evaluated at 3, 6 and 9 hours after surgical treatment using a visual subjective evaluation scale (VAS for adults and FES for children). The percentage of adults who referred pain of minor intensity was greater in the treated patients than in the controls: 51.4% vs 14.3% (p&lt;0.001) at the third hour, 71.4% vs 2.9% (p&lt;0.001) at the sixth hour and 88.6% vs 14.3% (p&lt;0.001) at the ninth hour. In the pediatric groups, 80.0% of the treated subjects referred moderate pain at the third hour, compared to 40% of the control group. At the ninth hour all children (100%) referred moderate pain compared to 20% of the control group. No treated patient required analgesic therapy during the post-operative observation period. The application of EMLA in the compartment after tonsillectomy determined an extremely significant reduction of postoperative pain in terms of intensity and duration.

Evaluation of Bupivacaine with Epinephrine Infiltration in post-Tonsillectomy pain Relief

Evaluation of Bupivacaine with Epinephrine Infiltration in post-Tonsillectomy pain Relief

Paracetamol has similar efficacy to pethidine for the treatment of post-tonsillectomy pain in children,

Paracetamol has similar efficacy to pethidine for the treatment of post-tonsillectomy pain in children,

Effects of intraoperative i.v. acetaminophen vs i.m. meperidine on post-tonsillectomy pain in children

Enteral acetaminophen, when used alone, is not very effective for postoperative analgesia because of delayed absorption and sub-therapeutic plasma concentrations. In contrast, i.v. acetaminophen is devoid of these shortcomings and could potentially provide adequate postoperative analgesia as a single agent. This randomized double-blind study compared the analgesic effects of i.v. acetaminophen and i.m. meperidine in paediatric patients undergoing tonsillectomy. Eighty children undergoing tonsillectomy were randomized to receive either acetaminophen 15 mg kg(-1) i.v. (acetaminophen group) or meperidine 1 mg kg(-1) i.m. (meperidine group), intraoperatively. Anaesthesia was induced with either sevoflurane inhalation or propofol, and was maintained with sevoflurane. After operation, the objective pain scale (OPS), Ramsay sedation score and Aldrete score were recorded every 5 min, and nurses' satisfaction was determined on a 7-point scale (1-7). On admission to the recovery room, OPS scores were 3.1 (sem 0.3) for the acetaminophen group and 2.1 (sem 0.3) for the meperidine group (P=0.147); however, Ramsay sedation scores were 3 (sem 0.2) and 4 (sem 0.3) for the acetaminophen and meperidine groups, respectively (P<0.05). Patients in the meperidine group continued to be more sedated 5 min after arrival in recovery (P<0.05). Acetaminophen group patients achieved an Aldrete score of 10 min sooner than those in the meperidine group [median (IQR) time: 15 (0-20) min vs 25 (15-30) min, respectively, P=0.005]. Adjusted nurse satisfaction scores were similar in both groups [6.1 (sem 0.2) vs 5.7 (sem 0.2) min, P=0.311]. Compared with i.m. meperidine, i.v. acetaminophen provided adequate analgesia, less sedation and earlier readiness for recovery room discharge among paediatric patients undergoing tonsillectomy.

Comrarative study of infiltration and surface application of bupivacaine in post tonsillectomy pain.

The concept of preamptive analgesia using bupivacaine to minimize post operative pain is a well established fact in surgery today. But the role ol bupivacaine to control post operative pain in tonsillectomy is still viewed with some degree of suspicion. The review of medical literature gives us conflicting views regarding its use. We present a randomised double blind study of 80 cases in which bupivacaine was used in the form of infilteration (preoperatively and packs (postoperatively) to minimize post tonsillectomy pain. The results were statistically analysed using 't' test and bupivacaine was found to be highly effective in minimizing post operative tonsillectomy pain. But the superiority of one method of application over the other could not be established.

Ketoprofen and tramadol for analgesia during early recovery after tonsillectomy in children

Pain following tonsillectomy is often intense. Nonsteroidal anti-inflammatory drugs and opioids are effective, but both can cause adverse effects. Tramadol may be a viable alternative for post-tonsillectomy pain. This study was designed to compare the analgesic effects of ketoprofen and tramadol during the early recovery period after tonsillectomy. Forty-five ASA class I children (9-15 years) were randomized to receive either saline, ketoprofen (2 mg.kg(-1)) or tramadol (1 mg.kg(-1)) after induction of anesthesia. Upon completion of surgery, the study treatment was continued as a 6 h intravenous (i.v.) infusion of another dose of saline, ketoprofen (2 mg.kg(-1)) or tramadol (1 mg.kg(-1)). Postoperatively, each patient received rescue analgesia with patient-controlled analgesia (PCA) device programmed to deliver 0.5 microg.kg(-1) bolus doses of fentanyl. Postoperative pain was assessed using Visual Analog Scale (VAS) during swallowing. Intraoperative blood loss was measured. The total number of requests of PCA-fentanyl was significantly less in ketoprofen group compared with tramadol and placebo groups (P = 0.035 and P = 0.049, respectively, in pairwise comparisons) and the VAS scores for pain were significantly lower in ketoprofen group compared with tramadol (P = 0.044) or placebo groups (P = 0.018) during the first six postoperative hours. Measured intraoperative blood loss was greater in ketoprofen-treated patients than in those receiving placebo (P = 0.029). A dose of 4 mg.kg(-1) of i.v. ketoprofen provided good pain relief with moderate supplemental PCA-fentanyl requirements during the first six postoperative hours after tonsillectomy in children whereas the effects of 2 mg.kg(-1) of i.v. tramadol did not differ from those of placebo.

Steroids for Post‐Tonsillectomy Pain Reduction: Meta‐Analysis of Randomized Controlled Trials

To determine whether meta-analysis supports the use of corticosteroids to reduce post-tonsillectomy pain for pediatric patients. A systematic review of currently available randomized controlled trials using a single-dose, intravenous corticosteroid during pediatric tonsillectomy was performed. Visual analog pain scale (VAS) data was extracted with reviewers blinded to results. Meta-analysis was performed with weighted mean difference and random-effects model using Revman 4.2 software. Eight randomized trials were included in analysis of post-tonsillectomy pain. A statistically significant reduction in pain as measured by VAS on postoperative day 1 was noted (mean VAS difference = -0.97; CI 95 % = -1.74,-0.19; P = 0.01). A single, intraoperative dose of dexamethasone may reduce post-tonsillectomy pain on postoperative day 1, by a factor of 1 on a 10-point pain scale. As the side effects and cost of dexamethasone dose appear negligible, consideration of routine use seems reasonable.

Ropivacaine compared to bupivacaine for post-tonsillectomy pain relief in children: A randomized controlled study

To compare the effects of ropivacaine and bupivacaine on post-tonsillectomy pain in children. Forty-six children aged 2-12 years, undergoing tonsillectomy were enrolled in the study. Group 1 (n=16) received bupivacaine, group 2 (n=15) received ropivacaine, and a group 3 (control) (n=15) received 9% NaCl (saline) infiltrated around each tonsil. Pain was evaluated using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) recorded 15 min and 1, 4, 12, 16, and 24h postoperatively. No difference was found in the demographic data among the groups. The pain scores were similar between the bupivacaine and ropivacaine groups (p>0.05). The pain scores in both analgesia groups were significantly (p<0.05) lower 1, 4, 12, 16, and 24h postoperatively compared to the control group. Analgesic requirements and the time to first analgesia were also significantly (p<0.05) different between the analgesia and control groups. Local ropivacaine infiltration is a safe and effective method and equivalent to bupivacaine for post-tonsillectomy pain.

The Effect of Preoperative Dexamethasone on Profopol Injection Pain, Postoperative Nausea and Vomiting Undergoing Otolaryngology-Head and Neck Surgery

Background: Induction with propofol has a high incidence of pain, as well as postoperative nausea and vomiting (PONV). The aim of this study was to assess the effect of a course of dexamethasone on the pain, postoperative nausea and vomiting associated with a Propofol injection, in patients undergoing otolaryngology-head and neck surgery. Methods: One hundred twenty adults, 20-60 years of age, ASA physical status I or II, were allocated to one of two groups. Either dexamethasone 5 ml (8 mg) or saline 5 ml was administered intravenously to each group. After 60 seconds, propofol was injected into the patients' hand veins over a 30 second period and the patient was asked questions regarding the injection pain after 10 seconds. Postoperative nausea, vomiting and post-tonsilectomy pain were recorded in the recovery room (1 h after surgery) and in the hospitalization area (6 h after surgery). Results: The severity and incidence of pain at the time of the propofol injection, PONV, and the level of post-tonsillectomy pain were significantly lower in the dexamethasone group than in the control group. Conclusions: The prophylactic intravenous administration of 8 mg dexamethasone is effective in reducing the severity of pain after a propofol injection and after the tonsillectomy, and decreased the incidence of PONV.

Comparison of Posttonsillectomy Pain Using the Ultrasonic Scalpel, Coblator, and Electrocautery

To compare postoperative tonsillectomy pain between 3 commonly used surgical devices: the Harmonic Ultrasonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH), the Coblator (ArthroCare Corp, Sunnyvale, CA), and electrocautery. A prospective, randomized trial. One hundred thirty-four patients were randomly assigned to receive a tonsillectomy with 1 of 3 surgical devices. All patients were asked to fill out a postoperative diary. Statistically significant differences in pain scores were revealed between the Coblator and electrocautery (P = 0.02) and between the Coblator and the Ultrasonic Scalpel (P = 0.003), with the Coblator having lower pain scores. Electrocautery and the Ultrasonic Scalpel did not differ significantly from each other. The Coblation method showed a strong trend toward quicker return to normal diet. Patients undergoing tonsillectomy with the Coblator device reported less pain over a 10-day period than patients undergoing tonsillectomy with electrocautery or the Ultrasonic Scalpel. Pain after tonsillectomy remains a major issue for our patients. The choice of surgical instrument appears to be one way to reduce this pain. A-1b.

Peripheral facial nerve paralysis after peritonsillar infiltration of bupivacaine: a case report

Peritonsillar infiltration of a local anesthetic solution for reduction of posttonsillectomy pain is commonly used although the benefit and complications of this technique have not yet been well established. We report a case of a 4-year-old boy who developed peripheral facial nerve paralysis after perioperative infiltration of bupivacaine and uneventful tonsillectomy. The paralysis was noticed a few minutes after extubation and resolved completely after 8 hours. We assumed this to be caused by the direct action of the local anesthetic agent on the facial nerve.

A randomized, placebo-controlled study of rofecoxib with paracetamol in early post-tonsillectomy pain in adults

Effective and early treatment of postoperative pain and nausea have become pivotal for the early discharge of patients after tonsillectomy. Opioid-based analgesia is standard practice but the use of non-steroidal anti-inflammatory drugs is discouraged due to their platelet inhibiting properties. The cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drugs are effective analgesics and do not affect platelet function. We hypothesized that premedication with cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drug in addition to paracetamol would provide effective analgesia and decrease opioid consumption during early recovery from tonsillectomy. In a randomized, placebo-controlled study of adult tonsillectomy patients (n=40) one group (R-group; n=20) was premedicated with paracetamol 1.5 g and rofecoxib 50 mg and a control group (P-group; n=20) was premedicated with paracetamol 1.5 g and placebo. Morphine was used as rescue medication. Postoperative (24 h) pain scores (0--10), morphine consumption as well as intraoperative blood loss were recorded. We found no overall difference in pain scores between the groups but significantly more patients in the placebo group had pain scores >5 within the first 8 h. The rofecoxib group consumed less morphine during the first 12 h. A lower intraoperative blood loss was observed in the rofecoxib group. Our results suggest an early although clinically minor analgesic benefit of the addition of a cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drug to paracetamol as premedication for adult tonsillectomy.

Clonidine effect on pediatric post-tonsillectomy pain: systemic versus local administration

Clonidine effect on pediatric post-tonsillectomy pain: systemic versus local administration

Steroids for Post-tonsillectomy Pain Reduction: Meta-analysis of RCTs

Steroids for Post-tonsillectomy Pain Reduction: Meta-analysis of RCTs