Post-tonsillectomy Pain Research Articles

Intraoperative acupuncture as complementary analgesic for post-tonsillectomy pain in children—a prospective randomised clinical trial of effects and safety

Background: Tonsillectomy in children is usually accompanied by significant morbidity, including postoperative bleeding, pain, nausea, vomiting, poor oral intake and dehydration. Recent evidences in literature suggest that acupuncture could play a role in reducing postoperative pain in these children. This study aims to investigate the effect of intraoperative acupuncture on postoperative pain scores and oxycodone requirements in children following elective adenotonsillectomy in a prospective randomized controlled trial. Methods: A total of 251 healthy children undergoing tonsillectomy or adenotonsillectomy, aged between 2 and 10 years old, were randomly assigned to either control or acupuncture groups. Preoperative block randomisation and allocation concealment were performed. All patients received standardised anaesthesia and surgery including intraoperative Morphine, Dexamethasone, Granisetron, Clonidine and Paracetamol. In the acupuncture group, acupuncture was additionally applied at 10 specified points immediately after induction of anaesthesia. Postoperative pain relief consisted of Paracetamol regularly and Oxycodone as required. All patients, nursing staff and parents were blinded. All assessments of postoperative pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale. Pain scores were recorded at regular intervals during the first 24 hours in hospital and on days 1, 2 and 5 at home following discharge. Results: There were 130 patients in control group and 121 patients in acupuncture group. Acupuncture treatment provided significant benefit for the initial postoperative pain. Pain scores were significantly lower in the acupuncture group compared to those in the control group in the first 12 hours but no difference was noted after discharge at home. There was no difference in the oxycodone requirements between the two groups in hospital but a significant reduction was noted in the acupuncture group on Day 2 at home. No significant adverse effects related to acupuncture treatment were observed. Conclusions: Our study lends support to other findings in the current literature that acupuncture is an effective supplemental tool for reducing early postoperative pain and Oxycodone requirement at home in children following adenotonsillectomy.

The effect of applying amniotic membrane on post-tonsillectomy pain and bleeding.

Pain and hemorrhage are common morbidities after tonsillectomy. Although many studies have focused on post-tonsillectomy pain, inadequate researches are available on wound healing. Hence, there is a definite need for a novel technique to facilitate the healing process and thereby improving the post-tonsillectomy recovery. This prospective and randomized study was conducted on 60 adult patients who underwent tonsillectomy. They were divided into two groups of control and amniotic membrane (AM). Human amniotic membrane was applied over the tonsillar bed as a biologic dressing. Post-tonsillectomy pain and bleeding were evaluated. Also, the healing rate was assessed on days 5, 10 and 15 post-operatively. The pain score in the AM group was lower than that in the control group during the first week after surgery (P < 0.0001). Moreover, the AM group returned faster to their normal diet in comparison with the control group (P < 0.0001). With respect to the healing rate, there were no significant differences between the groups on day 5 (P > 0.05), whereas a significant difference was seen on days 10 and 15 post-surgery (P < 0.0001). There was no significant difference between the two groups in terms of post-operative bleeding (P ≅ 1). We observed that the use of AM graft as a biologic dressing might be beneficial in reducing post-operative pain and promoting the wound healing process. The results represent a further step toward developing a new technique for coverage of tonsillar fossa with sheeting or wearing grafts.

#10-Year Challenge: Local anaesthetic for post-tonsillectomy pain: Update meta-analysis.

Adequate management of post-tonsillectomy pain is an important consideration in postoperative management after tonsillectomy. A 2008 meta-analysis showed that the use of local anaesthetic either by infiltration or topical application reduced postoperative pain. To review the current evidence for the use of local anaesthetic as a means of reducing post-tonsillectomy pain and compare current evidence to the previous meta-analysis 10years ago. Systematic literature searches of MEDLINE [*"ANESTHETICS, LOCAL"/ AND *TONSILLECTOMY/], EMBASE [*"LOCAL ANESTHETIC AGENT"/ AND *TONSILLECTOMY/] and PubMed [(Tonsillectomy).ti,ab AND (Local Anaesthetic).ti,ab OR (Local Anesthetic).ti,ab]. A meta-analysis of randomised control trials assessing the use of local anaesthetic agents for post-tonsillectomy pain. Twenty-three studies were included in the meta-analysis. Overall, local anaesthetic, applied topically or infiltrated, significantly reduces pain scores compared with controls at 4-6hours [-0.65 (95% CI: -0.77; -0.53)]; 24hours [-0.50 (95% CI: -0.66, -0.35)]; and 5-7days [-0.78 (95% CI: -0.90, -0.65)] (standardised mean differences). Current studies suggest that use of peri-operative local anaesthetic during tonsillectomy does improve postoperative pain outcomes. The limitations of the analysis are as follows: all studies are small, and a multi-centred larger trial is recommended to guarantee statistical reliability. There was no description of significant adverse side effects from local anaesthetic use.

Adult post-tonsillectomy pain management: Opioid versus non-opioid drug comparisons

Objective: The primary purpose of this retrospective study was to determine if a non-steroidal anti-inflammatory drug (diclofenac sodium) plus acetaminophen was as effective as alternative opioid drug regimens, +/- ibuprofen and acetaminophen, for pain management in adults following tonsillectomy. Study design: Retrospective study. Setting: 4 hospitals in Michigan associated with the Detroit Medical Center. Subjects and methods: Medical records of adult tonsillectomy patients (age 18 to 50 Years) were reviewed. The incidences of unscheduled post-operative visits to either the ER or ENT clinic for uncontrolled throat pain and/or postoperative bleeding complications were reviewed.

Trigeminal Nerve Blockade in the Pterygopalatine Fossa for the Management of Postoperative Pain in Three Adults Undergoing Tonsillectomy: A Proof-of-Concept Report

Post-tonsillectomy pain in adults can be severe and is often poorly controlled. Pain can lead to decreased oral intake, bleeding, longer hospital stays, emergency department visits, dehydration, and weight loss. Due to persistent pain despite scheduled medications, other methods for pain control are needed. Local/regional anesthetic options have been previously studied in this population. Unfortunately, neither the injection of local anesthetics into the tonsillar fossa nor the postoperative topical application of local anesthetics to the tonsillar bed has demonstrated efficacy in large systematic reviews. Here we report on the post-tonsillectomy pain experience of three patients who were treated with perioperative nerve blocks placed in the pterygopalatine fossa. This represents an as-yet unexplored option for post-tonsillectomy pain control. After induction of general anesthesia, before surgical incision, a 25-gauge spinal needle was advanced into the pterygopalatine fossa using a suprazygomatic, ultrasound-guided approach. Ropivacaine and dexamethasone were deposited into the pterygopalatine fossa. All three patients experienced excellent pain control for the duration of their recovery and required ≤10 mg of oxycodone over the two weeks after surgery. Our case series of three patients provides proof of concept that use of nerve blocks in the pterygopalatine fossa can be useful for the control of post-tonsillectomy pain. Further study is needed to confirm these initial results.

Analgesia for adenotonsillectomy in children: a comparison between peritonsillar infiltration of tramadol, ketamine, and placebo.

Post-tonsillectomy pain is mediated by nociceptive C-fibers located at peritonsillar space. Peritonsillar infiltration of medication could relieve post-operative pain blocking the afferent via. To evaluate the effect of peritonsillar infiltration of tramadol, ketamine, and placebo on post-operative pain in cases of adenotonsillectomy. This is a double-blind randomized placebo-controlled study. Children ASA I-II aged 3-13 years scheduled for adenotonsillectomy were included in the study. Patients were randomized to receive either 2 mg/kg of peritonsillar tramadol (Group T), 0.5 mg/kg of peritonsillar ketamine hydrochloride (Group K), and 3 mL of peritonsillar saline (Group P). Post-operative pain was recorded using the modified visual analogue scale at 2 h, 6 h, 12 h, and 24 h. Side effects, analgesia requirement, and first oral intake were also recorded. There were included 112 patients and five were excluded until final evaluation. We evaluated 36 children of Group T, 36 of Group K, and 35 of Group P. Groups were similar regarding to age, weight, height, gender, tonsil and adenoid size, hemodynamic parameters during the surgery, surgery, and anesthesia time. There were no differences between the groups in relation to pain scores, analgesia requirement, or first time of oral intake (p>0.05). Group T presented a higher incidence of vomit between 2 and 6 h after surgery (p>0.05). This study showed that peritonsillar infiltration of tramadol or ketamine were not superior to placebo in reducing post-operative pain in children undergone adenotonsillectomy. The use of tramadol increased the risk of nausea and vomit between 2 and 6 h after surgery.

Efficacy of Sucralfate in alleviation of postoperative morbidity after tonsillectomy.

Objectives: Despite of the therapeutic advancement, post-tonsillectomy pain is one of the most commonly observed morbidities associated with this surgical procedure which in turn highlights the need for appropriate analgesic consumption that assures safety and efficacy. Through this study our basic motive was to evaluate the sucralfate efficacy in the management of post-tonsillectomy symptoms during the first week of the surgery. Study Design: An Interventional, Quasi Experimental, (double-blind), purposive study. Setting: Department of Otorhinolaryngology and Head and Neck Surgery, Dow University of Health Sciences &amp; Civil Hospital Karachi. Period: From January to June 2018. Material &amp; Methods: One hundred and forty tonsillectomy patients of both genders between the age group of 7 to 35 years were randomly included in the study and categorized into 2 groups i.e. trial (Sucralfate group; Group A) and control (Pyodine group; Group B) with 70 patients in each group. The patients in group A were recommended to gargle with sucralfate suspension 4 times a day while following the same procedure except the group B interventional product was replaced with Pyodine mouth wash. The post-operative symptoms and secondary outcomes including pain, otalgia, odynophagia, analgesic requirements, slough shedding, bleeding and other associated side-effects were monitored. Pain, otalgia and odynophagia were assessed using the universal pain assessment tool (UPAT) while the secondary outcomes through a scoring system generated internally. Results: It is revealed from the study results that there was significant decrease in the throat pain and odynophagia in group A from 3rd to 7th post-tonsillectomy day (p &lt; 0.05); while the results were not very significant for otalgia. The same could be applied for other secondary outcomes i.e. the analgesic requirement greatly decreased in patients given sucralfate presenting faster recovery. Moreover, early return to normal diet was observed for the patients treated with sucralfate. No serious adverse effects observed among the patients both groups. Conclusion: Sucralfate can be recommended as the first choice of treatment for the management of post-tonsillectomy symptoms on the basis of its efficiency in treating pain and other symptoms and hence providing maximum safety.

AB223. Postoperative analgesia for adolescent tonsillectomy

Background: Post-tonsillectomy pain remains a significant problem for the older patient which is reflected in the medical literature. Paediatric pain after such surgery is much more manageable but continues to stimulate a significant amount of clinical discussion in publications. There is a dearth of information or guidelines on analgesia management in the adolescent patient after tonsil removal, our aim was to audit a group of such patients undergoing tonsillectomy since the introduction of a Palexia (Tapentadol) weight-related protocol for post-operative pain.

Comparative study between the effect of Diclofenac and Ketorolac in post-tonsillectomy pain management

Introduction: Tonsillectomy is one of the most common surgical procedures performed in children. It is associated with significant pain Ketorolac and Diclofenac are the commonly used NSAIDS for post-tonsillectomy pain; however, they may cause bleeding. Objective: To compare between the effect of diclofenac sodium and ketorolac in post-tonsillectomy pain management and bleeding. Materials and methods: 100 children aged 6-12 years were divided into two groups; Diclofenac group (n=50 patients who received diclofenac sodium analgesia) and Ketorolac group (n= 50 patients who received ketorolac tromethamine analgesia) .Intra-operative and postoperative blood loss was assessed using the following scale for bleeding assessment (0 = no bleeding, 1 = bleeding as usual, 2 = bleeding more than usual, 3 = profuse, 4 = excessive, and lastly 5 = excessive and continuous), while postoperative pain was assessed using the verbal rating scale, the total consumption of additional analgesics used in each group and the time needed to restore normal dietary habits Results: There were no statistical differences between the two groups regarding intraoperative and postoperative bleeding. On the other hand, there was no statistical difference between the two groups regarding postoperative pain management. Forty-eight and forty-six patients returned to their normal dietary habits in the first day post-operative in diclofenac group and ketorolac group respectively. Conclusions: Both ketorolac and diclofenac administered intraoperatively before the start of surgery and continued postoperatively, both drugs effectively and equally controlled post-tonsillectomy pain with no serious adverse effects.

Advantage of Application of Topical Hyaluronic Acid in Reducing Post Tonsillectomy Pain; Cross Sectional Comparative Study

Introduction: Tonsillectomy is common surgical operation performed in otolaryngology department. Various techniques could be used that include traditional cold dissection, powered instrumentation like electro cautery, harmonic scalpel, laser, and radiofrequency technique. As with any surgery, there are some risks can occur with tonsillectomy, these includes bleeding, pain at the site of surgery and/or referred otalgia, and infection. The aim of our study was to assess the postoperative use of topical hyaluronic acid with regards to safety, pain relief. Method: The research was considered a cross-sectional research made on 60 patients needing tonsillectomy from a period began from January to September 2018. The patients had been separated into two groups both from 30 patients, one group (group A) treated by using high molecular weight(HMW) Hyaluronic acid spray on tonsillar beds after operations , and the second group(group B) dealt as control. Early complications were registered in questionnaires and then the data were evaluated for each group. Results: The use of high molecular weight (HMW) Hyaluronic acid spray on tonsillar beds after surgery has reduces the pain significantly after 3 – 7 days (p-value = 0.0001) while has no implication on pain reduction within12 - 24 hours p-value (0.17 and 0.3) respectively . Conclusion: The use of (HMW) hyaluronic acid spray can be used safely in post tonsillectomy patients. Hyaluronic acid spray can minimize post tonsillectomy pain.

Implications of a Retrospective Study on Weight-Based Risk for Post-Tonsillectomy Pain in Children

PurposeThe purpose was to examine if children experience weight-based risks for post-tonsillectomy pain (PTP) in the postanesthesia care unit (PACU). DesignThis retrospective correlational cohort design included a sample of 180 children between the ages of 4 to 12 years who had tonsillectomy and adenoidectomy or tonsillectomy before August 2016; half were obese (OB) or overweight (OW). MethodsThe sample was obtained from children who had surgery at a large pediatric hospital with an attached outpatient surgical center in North Texas. Children were defined as either OB and OW or non-OB and non-OW based on a cutoff of standardized body mass index z scores of 85th percentile and greater per the National Center for Health Statistics. Pain scores were obtained in the PACU after surgery. Early PTP was defined as the most severe pain experienced by a child in the first 15 minutes after extubation. Prolonged PTP was sustained and uncontrolled pain in the PACU. FindingsOB and OW status did not increase the likelihood of experiencing early PTP when examined by multiple logistic regression controlling for covariates (adjusted odds ratio, 1.391; P = .369). OB and OW status was associated with longer episodes of prolonged PTP (rs[178] = 0.16; P = .03). OB and OW children were more likely to experience prolonged PTP in the PACU (χ2[1] = 8.353; P = .004), with these children experiencing an average PTP period twice as long as their peers. ConclusionsOB and OW children did experience risk for prolonged PTP, averaging sustained pain for approximately twice as long as other children. The increased risk for prolonged PTP in OB and OW children occurred despite well-managed early PTP with rates that matched those of their peers. No weight-based risk for early PTP was observed. Further research is needed in the area of PTP management in OB and OW children.

Nasal Sprays Containing Mometasone Furoate For Relief of Post-Adenotonsillectomy Pain In Children: A Prospective Controlled Study

Objectives:Adenotonsillectomy is one of most common surgeries performed in childhood. Post-operative pain associated particularly with tonsillectomy is still a problem for many physicians. Despite advances in surgical techniques, analgesics, or anti-inflammatory drugs, no unique strategy for post-tonsillectomy pain management has been suggested. The aim of this study is to investigate the analgesic effect of steroid containing nasal spray applied to tonsillar region after tonsillectomy.Methods:Eighty-two patients were assigned into two groups as study and control. In study group, nasal spray containing steroid was applied to each tonsillar region after surgery for 5 days. Post-operative pain of all patients was assessed using a visual analog scale and results were compared.Results:Pain decreased gradually over time in both the study and control groups. Although the pain scores from 4 h post-surgery to post-operative day 5 were not found to significantly decrease in children that used nasal spray containing steroid, these patients developed less pain on post-operative day 5,with statistical significance (p<0.05).Conclusion:Post-tonsillectomy pain was reported to increase around post-operative day 5, which coincides with the time of intense wound inflammation. Therefore, significant pain reduction on post-operative day 5 observed in children that used nasal spray with steroid may have clinical importance for overcoming this problem.

Role of bupivacaine in reducing post tonsillectomy pain

Role of bupivacaine in reducing post tonsillectomy pain

A descriptive analysis of pediatric post-tonsillectomy pain and recovery outcomes over a 10-day recovery period from 2 randomized, controlled trials.

Pediatric tonsillectomy involves an often painful and lengthy recovery period, yet the extended recovery process is largely unknown. This article describes postoperative recovery outcomes for 121 children aged 4 to 15 (mean 6.6 years, SD = 2.3) years enrolled in 1 of 2 clinical trials of analgesia safety and efficacy after tonsillectomy. Postoperative analgesia included scheduled opioid analgesic plus acetaminophen/ibuprofen medication use (first 5 days) and “as-needed” use (last 5 days). Clinical recovery as measured daily by the Parents' Postoperative Pain Measure (PPPM; an observational/behavioral pain measure), children's self-reported pain scores, side-effect assessments, need for unanticipated medical care, and satisfaction with recovery over 10 days was assessed. Higher Parents' Postoperative Pain Measure scores were correlated with poorer sleep, receipt of breakthrough analgesics, distressing side effects, higher self-reported pain scores, and need for unanticipated medical care. Higher self-reported pain scores were associated with more distressing adverse events, including nausea, vomiting, insomnia, lower parent satisfaction, and unplanned medical visits and hospitalizations. Pain and symptoms improved over time, although 24% of the children were still experiencing clinically significant pain on day 10. Scheduled, multimodal analgesia and discharge education that sets realistic expectations is important. This study adds to the emerging body of literature that some children experience significant postoperative pain for an extended period after tonsillectomy.

Effects of bupivacaine infiltration for controlling post-tonsillectomy pain: A systematic review and meta-analysis

Effects of bupivacaine infiltration for controlling post-tonsillectomy pain: A systematic review and meta-analysis

Preemptive Dexamethasone Reduces Pediatric Post-Tonsillectomy Pain: A Triple-Blind Randomized Clinical Trial

Preemptive Dexamethasone Reduces Pediatric Post-Tonsillectomy Pain: A Triple-Blind Randomized Clinical Trial

Does Ice Cream Help With Post-tonsillectomy Pain

Does Ice Cream Help With Post-tonsillectomy Pain

Reducing Post-tonsillectomy Pain by Tonsil Pillars Suturing.

Reducing Post-tonsillectomy Pain by Tonsil Pillars Suturing.

Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial.

Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo ( p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

Impact of cold dissection tonsillectomy method combined with selective low voltage bipolar diathermy cauterization on the post tonsillectomy pain in the pediatric age group

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pediatric tonsillectomies are commonly performed by cold&lt;strong&gt; &lt;/strong&gt;dissection or electro cautery dissection. Both the techniques have been compared in many articles for their role in controlling the post-operative pain and bleeding. With the electro cautery dissection the blood loss is comparatively less, but the post-operative pain is reported as more. Several expensive new techniques are available to address the problems. A simple technique of cold dissection tonsillectomy combined with selective low voltage bipolar diathermy cauterization performed in the pediatric age group is being studied retrospectively for its impact in managing the post-operative pain.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The case records of 73 patients aged 4-15 years who were operated for tonsillectomy from January 2018 to July 2019 are retrospectively studied. 33 patients underwent cold dissection and ligature tonsillectomy and 40 patients underwent tonsillectomy by cold dissection combined with selective low voltage bipolar diathermy cauterization. The postoperative pain incidence in these two groups is studied. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The cold dissection tonsillectomy combined with selective low voltage bipolar diathermy cauterization technique was found to be useful in managing the postoperative pain in pediatric tonsillectomies.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Performing&lt;strong&gt; &lt;/strong&gt;cold dissection tonsillectomy with precise mucosal incision, gentle&lt;strong&gt; &lt;/strong&gt;dissection and combining it with selective low voltage bipolar diathermy cauterization of the bleeding points was found to be helpful in controlling the postoperative pain in pediatric tonsillectomies. Prescribing a syrup form of NSAID from the second post-operative day was found to be of additional help.&lt;/p&gt;