Postoperative Tonsillectomy Pain Research Articles

A Comparative Study of Post Operative Pain Following Tonsillectomy with Local Infilteration of Dexamethasone vs Triamcinolone.

Tonsillectomy till date continues to be the most frequently performed surgery by ENT surgeons, and with that comes the most challenging complication of post-tonsillectomy pain and its management that affects the patient morbidity and alters the hospital course. Various methods and techniques have been implicated in the post-operative pain management in patients undergoing tonsillectomy. To compare the post operative pain following local infiltration of Dexamethasone and Triamcinolone in patients undergoing Tonsillectomy. Total of 50 patients were selected and randomized into two groups- Group 1 and Group 2, who underwent local infiltration of Dexamethasone and Triamcinolone respectively to maintain uniformity. Baseline scoring (0h post operatively) and follow up scoring after 6h and 24h was done using the Visual Analogue Scale and were evaluated and documented as per their response to treatment. A significant reduction was observed in the severity of pain in both groups with an average reduction of mean score from 9.50 to 5.92 in Group 1 and from 9.04 to 3.90 in Group 2 at the end of 24h post-operatively. The mean score of Group 2 was greater and showed better improvements in VAS pain score and was statistically significant (p < 0.001). Usage of steroidal preparations locally during tonsillectomy helps combat the post-operative pain. Usage of Triamcinolone locally has proved beneficial in reducing the post-operative tonsillectomy pain.

Comparison of Pain Scores between Intravenous versus Rectal Acetaminophen in Children Undergoing Tonsillectomy

Background: Post-operative tonsillectomy pain is widely observed especially among children which leads to longer hospitalization, slower recovery, eating disorder and continuation of IV fluids ingestion. Objective: To compare mean pain scores between intravenous versus rectal acetaminophen in children undergoing tonsillectomy. Study Design: Randomized controlled trial Place and Duration of Study: Department of Anesthesiology, Surgical Intensive Care &amp; Pain Management, Civil Hospital Karachi, Dow University of Health Sciences, Karachi from 15th July 2015 to 14th January 2016. Methodology: Seventy eight patients with American Society of Anesthesiologist Physical Status (ASA) I and II having age 4-10 years of either gender presented with chronic tonsillitis and duration of disease of more than or equal to one year and underwent elective surgeries (tonsillectomy) were enrolled. Patients were randomly allocated by computer generated random number in two groups; group A received intravenous acetaminophen and group B received rectal acetaminophen. In group A, intravenous acetaminophen 10mg/kg was given and in group B, rectal acetaminophen 15mg/kg was given. Postoperative pain was assessed after 4 hour in ward based on CHIPPS criteria. Results: Mean age was 6.69 2.12 years in intravenous group whereas 5.94±1.97 years in rectal group (P=0.114). Mean duration of disease in intravenous group was 1.82±0.72 years whereas in rectal group, it was 2.07±0.62 (P=0.097). Mean pain score in intravenous group was 2.65±0.05 and 1.97±0.01in rectal group (P=0.001). Conclusion: Significant difference was observed in mean pain scores between intravenous versus rectal acetaminophen in children undergoing tonsillectomy Keywords: Tonsillectomy, Intravenous versus rectal acetaminophen, Pain scores

Efficacy of topical 0.5% bupivacaine in pain reduction in pediatric tonsillectomy patients

BACKGROUND &amp; OBJECTIVE: Palatine tonsils are lymphoid organs in the oropharynx part of the waldeyer's ring and serve as host defence organs with maximum immunological activity from 3-10 years. Tonsillectomy is associated with considerable postoperative pain and requires significant consumption of analgesia. This study aimed to determine effect of topically suffused 0.5% bupivacaine on postoperative tonsillectomy pain.&#x0D; RESULTS One hundred &amp; twenty (120) patients with 61 males and 60-patients in each group with age range of 5-15 years (Group-A=8.63±2.63 and Group-B=8.32±6.60 in). Mean BMI of Group-A and group-B was 15.18±1.60 and 14.96±1.34 respectively (p=0.417). Mean pain score in group-A and group-B was 2.63±0.938 and 6.07±0.800 respectively (p&lt;0.001).&#x0D; CONCLUSION: nsillectomies performed using bupivacaine-soaked packs postoperatively are associated with lower postoperative pain compared with those packed with normal saline.

Comparison of post operative pain in tonsillectomy: a three year prospective study

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tonsillectomy is the oldest surgery performed by otorhinolaryngologists worldwide. Through ages different techniques have been tried to improve the post surgical outcome and reduce morbidity among patients. Aim of the current study was to compare the post-operative pain among the patients undergoing tonsillectomy by cold dissection, bipolar cautery dissection and coblation dissection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 142 Patients undergoing tonsillectomy in ENT department of TMMC during the period of 3 year were included in the study. Patients were randomly distributed to undergo different techniques of tonsillectomy. The post-operative pain in patients was assessed using the pre-standardized visual analogue pain scale and results were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; No statistically significant difference was found among the groups undergoing tonsillectomy by cold dissection, bipolar dissection and coblator dissection as the p&amp;gt;0.05. The immediate post-operative pain was found to be slightly higher among the group undergoing tonsillectomy by coblator dissection and the analgesics dose needed in the post-operative period remained the same for all for patients of all the three groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; No statistically significant difference was found in the post-operative pain scores of patients undergoing tonsillectomy by CD, BD and CBD techniques.&lt;/p&gt;

Role of Pre-incisional Bupivacaine Infiltration in Post-tonsillectomy Analgesia.

Tonsillectomy is one of the common surgeries performed by Otorhinolaryngologists and is associated with several morbidities with pain being the commonest, which can cause considerable delay in oral intake and discharge from the hospital. As a commonly performed day care procedure nowadays, pain control is much better than what it used to be previously observed. Therefore newer drugs are being constantly studied inorder to give better analgesia and post operative comfort to the patient with minimal side effects. The main obstacle being finding the best medical method to control pain with minimum side effects, but at the same time making sure that the patient is adequately hydrated and they resume regular eating as soon as possible. Our aim is to study the role of pre-incisional 0.5% bupivacaine versus normal saline infiltration in post-tonsillectomy analgesia. Over a period of 1year, 30 patients with each group of 15 were compared for the efficacy of 0.5% bupivacaine and 0.9% normal saline in post-operative tonsillectomy pain management. After thorough clinical examination and investigations, all patients underwent tonsillectomy by dissection and snare method. After intubation, 0.5% bupivacaine or normal saline was infiltrated in the tonsillar fossa and pain scores was obtained using Visual Analogue Scale (V.A.S) at 6, 12 and 24h post operatively. Using Mann-Whitney non-parametric statistical test, inter-group analysis was done which showed highly significant p-value (<0.0001) indicating that the pre-incisional bupivacaine infiltration is highly effective in reducing the post-tonsillectomy pain. Hence, we recommend the routine use of pre-incisional peritonsillar infiltration of 0.5% bupivacaine in all tonsillectomy/adenotonsillectomy cases, irrespective of the age of the patient to reduce the post tonsillectomy pain and other discomfort associated with it.

Effect of Flurbiprofen spray on postoperative tonsillectomy pain

Background and objectives: Tonsillectomy is one of the most frequently performed surgical procedures. Up to date there are no guidelines for pain control following tonsillectomy. The aim was to determine whether oral spray flurbipro- fen reduces pain and has an influence on wound healing following tonsillectomy. Methods: A Prospective, randomized study was done in Rizgary Teaching Hospital (Erbil-Iraq). This study was conducted on 60 patients who underwent ton- sillectomy between July 2017 and July 2018. Patients were randomly chosen and they were divided into two groups (thirty patients included in test group received flurbiprofen spray, other thirty included in control group). For test group oral spray flurbiprofen was used 3 times a day, every time three puffs. Postoperative pain was evaluated on the 1st, 4th, 7th and 10th postoperative days. The Efficacy was evaluated by universal pain assessment tool. Wound healing was evaluated on the 1st, 4th, 7th and 10th postoperative days. Results: The flurbiprofen group include 30 patients (18 males, 12 females) with a mean age of 23 years (range 12-40 years); the control group consisted of 30 patients (16 males, 14 females) with a mean age of 22 years (range12- 40 years). The severity of throat pain was lower in the flurbiprofen group when compared with the control group, and this difference was statistically highly significant for the 4th and the 7th day. Wound healing was not significantly different between the two groups. Conclusions: The use of flurbiprofen oral spray decreases postoperative tonsillectomy pain.

A randomized, single-blind, prospective trial of auricular 'battlefield' acupuncture for the reduction of postoperative tonsillectomy pain in adults.

The purpose of this randomized, single-blind trial was to evaluate the efficacy of battlefield acupuncture in reducing postoperative pain and opioid consumption after adult tonsillectomy. Adult participants undergoing a tonsillectomy were randomized to either receive auricular 'battlefield' acupuncture or not. Groups were compared using the Wilcox rank sum test, Fisher's exact test and a generalized estimating equations model for post-discharge pain scores. Statistically significant difference was not noted for morphine equivalent opioid use, nor was there any difference noted in the pain scores between the control group and treatment group. Acupuncture is cheap, safe and effective in many settings. Peri-operative battlefield auricular acupuncture did not reduce postoperative pain or opioid consumption in this study.

The effect of flurbiprofen oral spray and ibuprofen vs ibuprofen alone on postoperative tonsillectomy pain: An open, randomised, controlled trial.

This prospective clinical study was carried out to evaluate the analgesic efficacy and safety of oral spray form of flurbiprofen in the treatment of postoperative pain in tonsillectomy patients. Open, randomised, controlled clinical study. Tertiary care training and research hospital. One hundred (53 males, 47 females) with an age range of 18-53years old (mean 27.4±9.3 SD) undergoing tonsillectomy were enrolled in this prospective controlled study. Patients receiving oral ibuprofen and flurbiprofen as spray form were enrolled as study group (53), whereas patients receiving only oral ibuprofen were enrolled as control group (47) in postoperative period. Postoperative pain was evaluated through visual analogue scale on 12th hour, first, third and seventh days after surgery. The mean maximal pain score of patients who have received flurbiprofen spray and ibuprofen was 3.36±1.93 SD that was statistically lower than the mean maximal pain score of patients who were medicated with only ibuprofen which was 4.06±1.29 SD on postoperative seventh day (P=.013). This study revealed that addition of flurbiprofen spray to oral ibuprofen is effective in the management of postoperative pain in tonsillectomy patients with no notable complications.

Examining the effects of enhanced provider–patient communication on postoperative tonsillectomy pain: protocol of a randomised controlled trial performed by nurses in daily clinical care

IntroductionPlacebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by...

Natural course of tonsillectomy pain: A prospective patient cohort study

ObjectiveThe aim of this study was to determine the natural course of pain after tonsillectomy. MethodsThis study included 119 patients that underwent tonsillectomy between November 2013 and November 2015. After undergoing tonsillectomy, patients scored their pain using the visual analogue scale three times daily (morning, midday, and evening) for 2 weeks. A linear mixed model was used for statistical analyses. ResultsIncreasing postoperative days was negatively associated with pain following tonsillectomy surgery (estimated value [EV] of visual analogue score [VAS]/day=−0.42, 95% confidence interval [CI]=−0.43 to −0.41, P<0.001); the post-tonsillectomy pain curve illustrated this negative correlation. Postoperative pain was less in children and adolescents (≤18years old) than in adults (>18 years old) (EV=−0.81, 95% CI=−1.56 to −0.08, P=0.031). Mean tonsillectomy-associated pain on postoperative day 1 was 6.4 VAS. It decreased slightly to 5.3 VAS until postoperative day 7, after which it reduced sharply to 3.7 VAS within 3 days; on postoperative day 14 it had decreased to 1.6 VAS. Pain assessments were higher in the morning (EV=0.59, 95% CI=0.50 to 0.69, P<0.001) compared with assessments conducted in the evening. ConclusionThe natural course of postoperative tonsillectomy pain follows a gradual decline for 1 week after surgery, but decreases more rapidly after this period.

Improving postoperative tonsillectomy pain management in children – A double blinded randomised control trial of a patient analgesia information sheet

ObjectivesTo evaluate paediatric post-tonsillectomy pain management using oxycodone when a specific analgesia information sheet is included with standard postoperative information. MethodsOxycodone information sheets were randomly allocated to half the study children's post-tonsillectomy information pack. The trial was double-blinded to the surgeon, anaesthetist, nursing and administrative staff. Parents and children completed the pain assessment on day 3, 5 and 7. On day 10 the parents completed a questionnaire. ResultsA postoperative analgesia information sheet provides for higher satisfaction and knowledge for parents using oxycodone (p<0.001) and children have improved postoperative pain control, most significantly at day 5 (p<0.05). Parent assessment of the child's analgesia was superior with the oxycodone information sheet, most significantly at day 3 and 7 post operatively (p<0.05). There is also a positive correlation between the parents’ observed pain score and children's self reported pain score, with a low correlation efficient level observed (p<0.001). ConclusionsInformation sheets are useful in education and use of postoperative analgesia. The primary objective to explore the efficacy of the information sheet has proved to be successful in this setting. Given risks of opioid analgesia, it is recommended that postoperative information sheets be given to all parents, to provide for improved analgesia control and safe management of children in the postoperative period.

A multicenter, randomized, double‐blind placebo‐controlled, single dose trial of the safety and efficacy of intravenous ibuprofen for treatment of pain in pediatric patients undergoing tonsillectomy

Tonsillectomy is one of the most common pediatric procedures in the United States. An optimal perioperative pain control regimen remains a challenge. Intravenous ibuprofen administered at induction of anesthesia may be a safe and efficacious option for postoperative tonsillectomy pain. To determine whether preoperative administration of intravenous ibuprofen (IV-ibuprofen) can significantly decrease the number of doses of postoperative fentanyl when compared with placebo in pediatric tonsillectomy surgical patients. This was a multicenter, randomized, double-blind placebo-controlled trial conducted at six hospitals in the United States. A total of 161 pediatric patients aged 6-17 years undergoing tonsillectomy were randomized to receive either a single preoperative dose of 10 mg·kg(-1) IV-ibuprofen or placebo (normal saline). Postoperative pain was managed with intravenous fentanyl (0.5 μg·kg(-1)) on an as needed basis when the visual analog scale (VAS) was >30 mm and deemed appropriate by recovery room nurse/physician. The primary endpoint was the number of doses and amount of postoperative fentanyl administered postoperatively for rescue analgesia. There was a significant reduction in the number of postoperative doses and the amount of fentanyl administered after surgery in the IV-ibuprofen group compared with the placebo group (P = 0.021). There were no differences in the time to first analgesia request or the number of patients who required postoperative analgesia. There were no significant differences in the incidence of serious adverse events, surgical blood loss (P = 0.662), incidence of postoperative bleeding, or a need for surgical re-exploration between the treatment groups. Administration of IV-ibuprofen, 10 mg·kg(-1) , significantly reduced fentanyl use in pediatric tonsillectomy patients.

Reducing postoperative pain from tonsillectomy using monopolar electrocautery by cooling the oropharynx.

Objective Evaluate intraoperative cooling of the oropharynx to reduce postoperative pain in tonsillectomy using monopolar electrocautery. Methods Sixty-six patients, age 1 to 12 years, were selected for the study, 33 in the control group and 33 in the experimental group. After randomization, patients underwent subcapsular dissection and hemostasis with monopolar electrocautery. Patients in the experimental group had the oropharynx cooled after tonsil dissection and hemostasis for 10 minutes. The procedure was done through the oral cavity by irrigation with 500 mL of 0.9% saline, in temperatures between 5°C and 10°C, for 5 minutes. The evaluation of postoperative pain was made with the pain visual analog scale (VAS) for 10 days. As complementary data on the evaluation of pain, we recorded daily use of ketoprofen for pain relief. Results Pain after tonsillectomy assessed by VAS was significantly lower in the experimental group at days 0, 5, and 6 (p < 0.05). There were no differences in the use of ketoprofen between the groups. Conclusion Cooling of the oropharynx after tonsillectomy promotes clinically significant reduction in postoperative pain, without additional complications.

Postoperative Tonsillectomy Pain Management: A Prospective Randomized Trial

Objectives: Examine the efficacy of three separate pain regimen groups for patients who have undergone tonsillectomies by multiple otolaryngologic surgeons at one institution. Methods: This study was an institutional review board (IRB) approved prospective randomized cohort study comparing the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen/hydrocodone, and acetaminophen/codeine for post-operative tonsillectomy pain control. Setting: A tertiary referral hospital. Patients of any age undergoing tonsillectomy from June 2011 until the present were randomized into one of three post-op pain regimen groups. All tonsillectomy procedures were performed using the same technique, no preoperative local anesthetic injections were given, and no post-operative antibiotics were provided. Patients/families were given a packet of information to complete that included pain control, time to return to diet, school/work, and baseline activity. Pain control was measured using a validated faces pain scale as well as the amount of drug being administered. Results: Eighty-five patients were enrolled in the study, and twenty-four patients completed the study packet: 11 patients from the ibuprofen arm, 7 patients from the acetaminophen/hydrocodone arm, and 6 patients from the acetaminophen/codeine arm. The preliminary data were analyzed with Kruskal-Wallis tests and demonstrated no significant difference in time to return to regular diet (p =0.867), time to return to work (p=0.849), or time to return to work/school (p=0.915). Conclusions: These preliminary results demonstrate efficacy of all three pain modalities with no significant difference in returning to pre-operative function.

The Influence of Administration Route in the Comparison of Dosage Forms

Dear Editor, The article by Mogadam et al. (1) regarding the comparison of analgesic effect of gabapentin and diclofenac on pain after tonsillectomy was interesting, as it explained the comparison of analgesic efficacy results of preoperative gabapentin and diclofenac administration on postoperative pain in tonsillectomy. However, it is noted that one of the main factors which influences the rate of drug absorption is the route of administration. Absorption of the same molecule, taken at the same dose, by the same patient, but under a different administration route or a different dosage form (e.g. capsule or suppository) will not have the same kinetics of absorption, nor the same bioavailability. Therapeutic efficacy can only be achieved after the absorption of the active drug. In rectal administration, in general, it usually takes 5-30 minutes for the drug to be absorbed from rectum, whereas capsules must be first dissolved so as to release the drug powder. The effect of orally administered drugs is largely dependent on the rate of absorption from the gastrointestinal tract and absorption of drug takes place the whole length of the gastrointestinal tract (2). The authors mentioned the results of Biyik et al.’s paper and reported that both gabapentin and diclofenac had an effect on postoperative pain and in which gabapentin’s analgesic effect is found longer (3). I want to remind Mogadam et al. that in this study both gabapentin and diclofenac were administered in the same route; orally, so their effect was comparable. In my opinion, examination of two variables (different administration routes and two different active ingredients) at the same time makes the experimental design of the study difficult to compare. It may be of more interest examining the analgesic effect of gabapentin and diclofenac’s rectal administration on post-operative pain in patients undergoing tonsillectomy.

Gabapentin and Post Tonsillectomy Pain-The Next Best Thing?

Gabapentin and Post Tonsillectomy Pain-The Next Best Thing?

Efficacy of single dose perioperative intravenous steroid (dexamethasone) for postoperative pain relief in tonsillectomy patients.

To determine the efficacy of single dose perioperative intravenous steroid (dexamethasone) for postoperative pain relief in patients undergoing tonsillectomy. Quasi-experimental study. Combined Military Hospital, Lahore, from November 2009 to June 2010. Sixty patients were divided into two equal groups. A single dose of dexamethasone was given to patients of group A during induction of anaesthesia, whereas no steroid was given to the patients in group B. Postoperative pain scores were assessed at 2, 6 and 12 hours in both groups using visual analogue scale (VAS). Pain was classified as mild (0-3), moderate (4-7) and severe (8-10) on visual analogue scale. There was no significant difference in pain scores after 2 hours postoperatively. Pain scores of Group A at 6 and 12 hours postoperatively were found to be significantly low than Group B. Single dose perioperative intravenous injection of dexamethasone in tonsillectomy patients reduces postoperative tonsillectomy pain.

入院加療を行った扁桃周囲膿瘍２１５例

In a retrospective clinical peritonsillar abscess study, we reviewed 215 cases—169 men and 46 women from 8 to 85 years old (median: 34.5)—hospitalized and treated between January 2001 and December 2009. Of these, 111 (51.6%) were affected on the right side, 99 (46.0%) on the left, and 5 (2.3%) bilaterally. Abscess formed in the superior poles of 192 (89.3%), the inferior of 19 (8.8%), and bilaterally in 4 (1.9%). The smoking ratio was 78.6% in men and 48.7% in women. Bacteriological examination in 127 showed etiological bacteria of 107 strains—70 aerobic—mostly S. milleri (41.4%) and S. pyogenes (31.4%)—and the remainder anaerobic—Bacteroides (29.7%), Porphyromonas (29.7%), and Peptostreptococcus (21.6%). The ratio of antibiotic bacteria resistance was 22.4% to PIPC, 5.6% to FMOX, 11.2% to CLDM, 6.5% to LVFX, and none to IPM/CS. Of our subjects, 141 (65.6%) were treated by incision, 34 (15.8%) by puncture, 38 (17.7%) by antibiotics, and 2 (1.0%) by abscess tonsillectomy. Antibiotics used most often were FMOX combined with CLDM. Among our 28 subjects (13.7%) undergoing tonsillectomy—2 abscess and 26 interval—69.2% felt that acute peritonsillar abscess throat pain was severer than postoperative tonsillectomy pain. Peritonsillar abscess recurred in 26 (12.7%), with younger subjects outnumbering older in tonsillectomy and recurrence of peritonsillar abscess. We recommend tonsillectomy after acute inflammatory healing in those with peritonsillar abscess recurrence and habitual angina.

Application methods of local anaesthetic infiltrations for postoperative pain relief in tonsillectomy: a prospective, randomised, double-blind, clinical trial

Perioperative local anaesthetics are often used to reduce the postoperative pain in tonsillectomy. There exist three different ways of applying local anaesthetics: (1) pre-incisional peritonsillar; (2) post-tonsillectomy wound infiltration; (3) post-tonsillectomy packing with soaked gauze. The objective of the study is the evaluation of differences of pain reduction comparing the three different techniques of application. The study design mainly includes intra-individual, prospective and double-blinded. One hundred and eighty patients (3-45 years) with recurrent tonsillitis were included. The charts of 156 were eligible for analysis. Bupivacaine was applied on both sides randomized in different ways. Pain on each side was registered for 6 days on the ward by a blinded nurse. When directly compared with the other two application methods, the post-tonsillectomy injection of bupivacaine provides significantly better results during the monitored time period. Postoperative bleeding was observed in 11 (7.3%) cases without any correlation to an application procedure. No other adverse effects were observed. In conclusion, post-tonsillectomy infiltration of the wounds with bupivacaine is superior to pre-incisional infiltration technique as well as post-tonsillectomy packing of the wounds with 0.5% bupivacaine-soaked gauze swab.

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.