Postoperative Throat Pain Research Articles

The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial

Study objectiveThis study aims to evaluate the impact of Supreme™ laryngeal masks versus endotracheal tubes on atelectasis during general anesthesia using lung ultrasound (LUS), and provide evidence for respiratory management. DesignA single-center, double-blind, randomized controlled trial was conducted. SettingThe study was conducted in both the operating room and the post-anesthesia care unit, with follow-up assessments performed in the ward. PatientsEnrollment included 180 cases undergoing non-laparoscopic surgeries in gynecology, urology, and orthopedic limb surgeries. InterventionsPatients were randomly assigned 1:1 to the endotracheal intubation or laryngeal mask group. MeasurementsLUS scores were recorded across 12 lung regions at baseline, 15 min after airway establishment, at the end of surgery, and 30 min following airway removal. Outcome measures encompassed the oxygenation index, dynamic lung compliance, incidence of postoperative pulmonary complications, throat pain, and other postoperative complications assessed at 24 and 48 h postoperatively. The primary outcome focused on the LUS score in all 12 lung regions at 15 min after airway establishment. Main resultsIntention-to-treat analysis of 177 subjects revealed endotracheal intubation led to significantly higher LUS scores at 15 min {P < 0.001, mean difference 4.15 ± 0.60, 95% CI [2.97, 5.33]}, end of surgery (P < 0.001, mean difference 3.37 ± 0.68, 95% CI [2.02, 4.72]), and 30 min post-removal (P < 0.001, mean difference 2.63 ± 0.48, 95% CI [1.68, 3.58]). No major complications occurred in the two groups. ConclusionsCompared to endotracheal intubation, laryngeal masks effectively reduce atelectasis formation and progression in gynecological, urological non-laparoscopic, and orthopedic limb surgeries. However, caution is warranted when generalizing these findings to surgeries with a higher risk of laryngeal mask leakage or obese patients. Additionally, the efficacy of laryngeal masks in reducing postoperative atelectasis remains uncertain when comprehensive monitoring of muscle relaxation and reversal therapy is employed.

Interest of pharyngeal packing in head and neck surgery: a meta-analysis

Introduction: There is controversy regarding the use of pharyngeal packing in oral and nasal surgery. The primary objective of this study was to examine the association between pharyngeal packing, throat pain, and postoperative nausea and vomiting (PONV) in head and neck surgery. Material and methods: A systematic review of clinical studies published from January 2000 to August 2020 concerning the use of pharyngeal packing in head and neck surgery was conducted in the Medline, ScienceDirect and Cochrane Library databases. Throat pain and PONV were collected in each article, and a meta-analysis was performed. Results: A total of 10 clinical trials involving 877 patients were included in the meta-analysis. Pharyngeal packing did not significantly decrease PONV score either during the immediate (OR = 0.90, 95% CI: 0.59 to 1.38, p = 0.52, I2 = 0%) or the delayed postoperative period (OR = 0.88, 95% CI: 0.54 to 1.43, p = 0.28, I2 = 21%), but significantly increased the immediate postoperative throat pain score (MD = 0.68, 95% CI: 0.21 to 1.16, p = 0.19, I2 = 35%). Conclusion: This study suggests that the use of a pharyngeal packing to improve the preoperative aftermath in head and neck surgery should not be recommended.

An intubation method for mono-pulmonary ventilation in patients with difficult airway.

This study aimed to compare the clinical effect between thermal softening PVC double-lumen tube (DLT) and single-lumen tube (SLT) guided by laryngoscope and bronchoscopy in patients with difficult airways. 72 patients with chest surgery in need of mono-pulmonary ventilation, aged 20-70 years old, with ASA rating I-III and Arné scoring ≥ 11, were enrolled. Patients were categorized randomly into two groups with 36 patients in each: the D group (DLT was used) and the S group (SLT was used). Bronchoscopy was used for guiding the intubation and aligning in both groups. Laryngoscope would also be used immediately after failure in two trials of intubation. Intubation resistance, intubation success rate, laryngoscopy assist rate, time for intubation, time for alignment, incidence of catheter dislocation, VAS score for post-operative throat pain, and the damage extent of vocal cord were recorded. No significant differences were seen between two the groups in terms of intubation resistance, intubation success rate, laryngoscopy assist rate, time for intubation, VAS score for post-operative throat pain, and the damage extent of vocal cord. However, shorter time for alignment and lower incidence of catheter dislocation were observed in the D group than in the S group (both p < 0.05). For intubation in patients with difficult airway, the thermal softening DLT was as safe as the SLT, but simpler in alignment and had a lower dislocation incidence. Meanwhile, video laryngoscope could increase the success rate of intubation with either tube.

Effect of Throat Pack Placement on the Incidence of Sore Throat and Postoperative Nausea and Vomiting in Septorhinoplasty Patients: A Randomized Controlled Trial.

Advances in surgical and anesthetic techniques have led to a growing interest in performing procedures at ambulatory surgery centers. However, procedures involving the oropharyngeal or nasopharyngeal region may lead to the ingestion of blood, which can lead to postoperative nausea and vomiting (PONV). To date, limited studies have largely failed to demonstrate the benefits of oropharyngeal throat packing. The authors aimed to investigate whether throat packing during elective septorhinoplasty increases the incidence of postoperative throat pain and assess its effects on PONV. A randomized, prospective, single-blinded study was performed on 101 patients undergoing elective septorhinoplasty who received oropharyngeal throat packing vs no packing to compare the incidence of PONV and throat pain in the immediate postoperative period in addition to postoperative day (POD) 1 and 2. The incidence and severity of postoperative throat pain were significantly greater in patients receiving throat packs in the immediate postoperative period and on POD 1. Significant differences in throat pain and incidence between the 2 groups diminished by POD 2. Patients having received throat packs also demonstrated a higher utilization of opioids in postanesthesia care unit. The incidence of PONV did not significantly differ between the 2 cohorts at any point of observations. The results of this study largely agree with previous data that throat packs may contribute to postoperative throat pain while not significantly altering the incidence of PONV. Considering these data, we do not recommend routine utilization of throat packing during elective septorhinoplasty.

Effect of Postoperative High-Concentration Oxygen on Recovery After Thyroid Surgery: A Prospective, Open, Randomized, Controlled Study.

ObjectiveTo investigate the effectiveness of high-concentration oxygen on the improvement of throat symptoms and voice changes after thyroid surgery and its protection of the parathyroid function.MethodsA total of 600 patients undergoing thyroid surgery who met the inclusion criteria were randomly divided into the experimental group (n = 300) and the control group (n = 300) by using a random number generator. The patients in the experimental group underwent high-oxygen treatment [FiO280 (8 L/min)] for 6 continuous hours after returning to the ward after surgery. The patients in the control group underwent low-oxygen treatment [FiO230 (2 L/min)] for 6 continuous hours after returning to the ward after surgery.ResultsThe postoperative incision pain score of patients in the experimental group was significantly better than that in the control group at 6 h (1.07 ± 0.80 VS 1.23 ± 0.95, P=0.031) and 12 h (1.08 ± 0.64 VS 1.20 ± 0.73, P=0.041). The postoperative throat pain score of the patients in the experimental group was significantly better than that of the control group at 6 h (1.40 ± 0.85 VS 1.59 ± 0.97, P=0.011) and 12 h (1.40 ± 0.85 VS 1.59 ± 0.97, P=0.019). The PONV score of the patients in the experimental group was significantly better than that of the control group at 12 h (0.09 ± 0.19 VS 0.14 ± 0.37, P=0.024). The Voice Handicap Index score of the patients in the experimental group was significantly better than that of the control group at 24 h (2.89 ± 5.92 VS 4.10 ± 6.31, P=0.017), 36 h (2.46 ± 5.06 VS 3.43 ± 5.97, P=0.035), and 48 h (2.46 ± 5.06 VS 3.43 ± 5.97, P=0.032).ConclusionHigh-concentration oxygen can alleviate PONV and pain after thyroid surgery, with less severe voice changes potentially. However, its effects on swallowing function, and parathyroid function need to be further verified.Clinical Trial Registration NumberChiCTR-IOR-17012765 (China Clinical Trial Registry clinical trial registration center [http://www.chictr.org.cn/index.aspx)

Re-Print-A Comparison between Conventional Throat Packs and Pharyngeal Placement of Tampons in Rhinology Surgeries.

Objective: the aim is to evaluate the incidence of postoperative throat pain, nausea and vomiting in patients that have been packed with either conventional gauze or pharyngeal tampons. Methods: We included adult patients who were booked for a rhinology surgery that needed throat packs. They were allocated into two groups, pharyngeal tampons, and conventional ribbon gauze. They were then assessed using visual analog scales and Post-operative nausea and vomiting impact scale respectively in the 1st, 4th, and 24th hour. Data was analyzed using SPSS software version 25. Results: There is evidence to suggest that using pharyngeal tampons reduces the mean VAS score at 4 hours compared to using Gauze. [t87=3.294, p=0.001), the is no statistical evidence that show a difference in the other Visual analogue scores or post-operative nausea and vomiting scores. Conclusion: The study shows that the use of pharyngeal tampons is associated with decreased pain scores, however, it also shows that there no difference in postoperative nausea and vomiting.

The use of throat packs in ear, nose and throat, oral and dental surgery: a systematic review.

Throat packs are placed around the airway in patients undergoing upper airway surgical procedures under general anaesthetic to prevent aspiration or ingestion of blood, and consequent chest infections or postoperative nausea and vomiting (PONV). There is no definitive evidence for this, and each time a pack is placed, it risks being retained and obstructing the upper airway. This study aimed to determine whether throat packs are of benefit to patients undergoing upper airway surgical procedures. Medline, Embase and Central were searched from conception to 15th January 2018 using individualised search strategies. A systematic search of multiple databases was undertaken using custom strategies to identify all relevant randomised controlled trials. Screening, risk of bias assessment and data extraction were undertaken independently by two authors. Primary outcomes included throat pain and PONV. Secondary outcomes included any adverse event documented. Thirteen papers were eligible for inclusion. No studies reported any instances of retained throat packs. Ten studies assessed the effect of throat packs on post-operative throat pain, with four papers showing a significantly higher incidence of pain when throat packs were used. One study showed throat pain to be slightly, but significantly, worse 24 hours post-surgery when a pack was not used. No paper showed throat packs to be of benefit in preventing PONV. The study was limited by methodological flaws of included trials, overall relatively low numbers of patients and difficulty in contacting authors to clarify information and obtain raw data. However, this systematic review found no evidence to support the use of throat packs. This supports the proposal that there is no indication for the routine use of throat packs in ENT, maxillofacial and dental procedures.

Tongue symptoms, suspension force and duration during operative laryngoscopy.

Suspension laryngoscopy is a commonly performed procedure in otolaryngology. During the procedure, the laryngoscope applies direct force to the tongue. Postoperative tongue symptoms include pain, swelling, numbness, taste disturbance, and rarely motor deficits. Duration and magnitude of force applied have previously been associated with post-operative throat and tongue pain, respectively. We sought to correlate postoperative tongue symptoms with magnitude of force applied and/or duration of suspension and investigate any risk factors for tongue morbidity. A sample of patients undergoing suspension laryngoscopy between 2015 and 2018 were prospectively recruited. Those with preexisting tongue symptoms, disease or surgery were excluded. Patients completed preoperative and postoperative questionnaires evaluating tongue swelling, numbness, motion and taste disturbance. Symptoms were subjectively scored on a visual scale from 0 to 10. Patient demographics, past medical and social history were also recorded. Intraoperative pressures were measured using a spring force scale, positioned between the suspension arm and Mayo stand. Initial and end suspension forces and duration of suspension were recorded. 120 patients met inclusion criteria, of which 63 completed both preoperative and postoperative questionnaires. 6 patients (9.5%) experienced postoperative tongue symptoms. Suspension force and duration of suspension were not significantly predictive of postoperative tongue symptoms. While all symptomatic patients were current or former cigarette smokers, smoking status was not found to be a statistically significant factor. Neither suspension forces nor duration of suspension were predictive of postoperative tongue morbidity. Further research is needed to evaluate the role of smoking status on postoperative tongue symptoms.

Comparison of the Baska mask and the i-gel supraglottic airway devices in patients undergoing elective surgery.

The Baska mask and i-gel are two new types of second-generation supraglottic airway devices. The aim of this study was to compare these two devices in terms of quality of insertion, quality of ventilation and post-insertion complications. A total of 80 adult patients who were scheduled for elective surgery under general anaesthesia were randomised to two groups: Group BM: Baska mask (n = 40) and Group IG: i-gel (n = 40). The assessment focused on ease of insertion, number of attempts, insertion time, number of corrective manoeuvres, oropharyngeal leak pressure, tidal volume, peak airway pressure (PAP) and post-insertion complications. Group IG showed a significantly shorter median insertion time (13.3 [interquartile range, IQR 7.8] vs. 17.0 [IQR 9.6] s; P < 0.001), a higher percentage in the 'very easy' ease of insertion category (62.5% vs. 10.0%; P < 0.001), a higher percentage in the no corrective manoeuvre category (92.5% vs. 72.5%; P = 0.003) and a higher percentage in the no post-operative throat pain category (67.5% vs. 32.5%; P = 0.011) than Group BM. However, Group BM showed a significantly higher generated PAP than Group IG (12.7 [1.8] and 11.5 [2.2] cm H₂O, respectively; P = 0.010). There were no significant differences in other parameters. The i-gel was better than the Baska mask in terms of ease of insertion, speed of insertion, fewer corrective manoeuvres and less post-operative throat pain. However, the Baska mask had a better cuff seal, as shown by a higher generated PAP.

Efficiency of I-gel supraglottic airway device during mechanical ventilation in supine and lateral decubitus position in obese patient; prospective observational study

ABSTRACT Background I-gel supraglottic airway device has been widely used recently in anesthesia practice as an alternative to endotracheal intubation. However, its safety and feasibility in obese patients are still under investigations. The aim of this work was to evaluate the efficiency of I-gel in supine and lateral position in adult obese (BMI 30–40) mechanically ventilated patients undergoing short surgical procedures (60 − 120 min). Methods Prospective observational study was conducted at Kasr Alainy Hospital. A total of 40 obese patients with body mass index 30–40 aged between 20 and 60 years, American Society of Anesthesiologists class II & III scheduled for elective surgeries were enrolled in one group. We used the I-gel in supine position and lateral position in the same patient. The primary outcome was comparison between Oropharyngeal leak airway pressure during controlled ventilation in supine position after insertion of I-gel by 1 min and in lateral position. The secondary outcomes were fiberoptic view , insertion attempts and postoperative upper airway complications Results The leakage pressure required for I-gel did not show statistically significant difference between both supine and lateral positions (33.88 ± 7.34 cmH2O versus 33.10 ± 7.58 cmH2O) respectively. Fiberoptic view ranged between score 2 (8 patients) and score 3 (32 patients) in both supine and lateral position. I-gel was inserted in the first trial in 37 patients, the second trial in two patients and the third trial in one patient. None of the patients experienced postoperative swallowing difficulties, throat pain, hoarseness or postoperative nausea and vomiting. Only two patients (5%) showed blood on I-gel after removal. Conclusion The use of I-gel supraglottic airway device is safe and effective in both supine and lateral position in obese patients under mechanical ventilation with reliable ventilation and no postoperative airway complications. Clinical trial registration clinicaltrial.gov. ID: NCT04119245

Effect of chlorhexidine/benzydamine soaked pharyngeal packing on throat pain and postoperative nausea & vomiting in orthognathic surgery

Pharyngeal packing is believed to reduce postoperative nausea and vomiting (PONV) frequency, but has the disadvantage of causing throat pain. The present study aimed to investigate whether applying pharyngeal packs soaked with a combination of chlorhexidine gluconate 0.2% and benzydamine hydrochloride 0.15% (CGBH) were effective in preventing postoperative throat pain and PONV in patients undergoing orthognathic surgery. A total of 101 patients scheduled for orthognathic surgery were enrolled in this prospective, double-blind, randomized study. Patients were randomly allocated into two groups: those with CGBH-soaked packing, and those with saline-soaked pharyngeal packing. PONV was recorded using a 5-point Likert scale (0: no PONV to 4: severe PONV) immediately after the surgery at 5, 10, and 30 min, and at 2, 4, 6, 12, and 24 h postoperatively. The severity of throat pain was assessed via two methods: visual analogue scale (VAS, 0: no pain, 10: severe pain) and 6-point Likert scale (0: no pain, 5: strongly severe pain) score at 2, 4, 6, 12, and 24 h postoperatively. Mean VAS scores of throat pain were significantly lower in patients receiving CGBH-soaked pharyngeal packs compared to patients receiving saline-soaked pharyngeal packs, at all measured time points. There was a tendency towards less PONV in patients receiving a CGBH-soaked pharyngeal pack compared to those receiving a saline-soaked pharyngeal pack; however, this difference did not reach statistical significance. The results of this study suggest that the usage of CGBH-soaked pharyngeal packs reduce postoperative throat pain in patients undergoing orthognathic surgery. Our results support the implementation of CGBH-soaked pharyngeal packing in orthognathic surgery practice, as a measure to improve patient comfort.

Moffett's Solution Causes Significantly Greater Postoperative Throat Pain Compared to Cophenylcaine in Sinonasal Surgery.

Aim Preoperative decongestion with Moffett's solution is routine practice in sinonasal procedures providing an ideal operative field. Anecdotally, it is related to postoperative throat pain, yet a quantitative relationship has not been established. We compare the incidence and severity of postoperative throat pain after application of Moffett's solution against Cophenylcaine decongestion. Methodology A total of thirty patients from two consultants were recruited. The intervention arm (twenty) was decongested with Moffett's solution and the control arm (ten) with Cophenylcaine. The primary outcome was self-reported postoperative throat pain as measured by visual analogue scale (VAS) at 2 hours, 4 hours, 6 hours, and next morning. Results There was a significantly higher VAS for throat pain in patients decongested with Moffett's solution in the early postoperative period (2 hours p=0.03, 4 hours p=0.04). Conclusion Moffett's solution is associated with a greater severity of transient postoperative throat pain compared to topical Cophenylcaine. We recommend further studies to identify means to minimise this side effect. Clinical Trial Registration This paper has been registered with the Australian and New Zealand Clinical Trials Registry under the registration number: ACTRN12619000772145.

Effect on postoperative pain after topical application of local anesthetics in the tonsillar fossa after tonsillectomy

BackgroundTonsillectomy is one of the most commonly performed surgeries in ENT practice. Despite improvements in anesthetic and surgical techniques, post-tonsillectomy morbidities continue to be a significant clinical concern. Pain is the cause of most of the postoperative morbidity after tonsillectomy. An effective pain therapy to block or modify the physiological responses to stress has become an essential component of modern pediatric anesthesia and surgical practice.AimThe present study compares the results between the effect of lidocaine 2% infiltration, lidocaine 10 % spray, and bupivacaine 0.5% spray in the tonsillar bed after tonsillectomy on postoperative pain.Materials and methodsThe study included a total of 120 patients aged 5–18 years who were candidates for tonsillectomy at the Otorhinolaryngology Department of Alexandria Main University Hospital. The patients were randomly divided into three groups of 40 patients each. Group A received lidocaine 2% (Xylocaine) peritonsillar infiltration 2ml in one tonsillar bed and posterior pillar; group B received lidocaine 10% (Xylocaine) spray 2 puff in one tonsillar bed; group C received bupivacaine 0.5% (Marcaine) solution 2ml in one tonsillar bed spray by syringe and the other tonsillar bed in each group receives pack with similar amounts of normal saline for 5 min as a control group after tonsillectomy before recovery from anesthesia.ResultsThere was no statistical difference between the three studied groups as regards age and sex. There is significant statistical difference according to the frequency of throat pain and ear pain by comparing cases and controls of each group within the first 24 h after surgery. It appears that increased frequency of postoperative throat pain and ear pain is present with the control side (saline).ConclusionTopical application of the tonsillar bed with a local anesthetic after tonsillectomy results in significant reduction of postoperative throat pain and referred otalgia and should be used during surgery for tonsillectomy.

Effect of Pharyngeal Pack on Postoperative Nausea and Throat Pain in Patients Undergoing Rhinoplasty

Objective: To evaluate the effect of pharyngeal pack on postoperative throat pain and nausea in rhinoplasty patients. Material and Methods: Twenty-eight patients were randomly selected and divided into two groups (n=14). The participants were randomly divided into two groups: G1 - the pharyngeal pack was used (Intervention group) and G2: not used (Control group). Both groups were anesthetized by the same protocol. Throat pain was measured by visual analog scale and nausea by presence / absence. Fischer’s exact test, ANOVA, Friedman and Wilcoxon test were used. Results: There was no significant difference in mean pain and presence or absence of nausea between the two groups (p>0.05). But there was a significant difference in mean pain and the presence or absence of postoperative nausea with the intervals (p 0.05). The presence or absence of postoperative nausea had a significant difference between 2 hours postoperatively with 24 and 72 hours postoperatively and 6 hours postoperatively with 24 and 72 hours postoperatively (p 0.05). Conclusion: None of the two groups were significantly superior in terms of reduction of pain and nausea, but because of the possible effectiveness of the pharyngeal pack in preventing aspiration of objects and tissues during the operation, the use of pharyngeal pack is recommended in patients.

Can Pharyngeal Packing Prevent Postoperative Nausea and Vomiting in Nasal Surgery?

We aimed to perform a meta-analysis for the efficacy of pharyngeal packing during nasal surgery in the prevention of postoperative nausea and vomiting (PONV). MEDLINE, SCOPUS, and the Cochrane database. Two authors independently searched the databases for relevant studies from inception to October 2017. Included studies were randomized controlled studies published in English comparing pharyngeal packing during intubation (packing group) with no packing (control group) in patients who underwent nasal surgery. Outcomes of interest included the incidence of PONV and throat pain during the first 24 hours postsurgery. Ten studies were included in the meta-analysis. The incidence of moderate-to-severe PONV in the recovery room was significantly higher in the packing group than in the control group. However, the incidence of moderate-to-severe PONV significantly decreased and was lower in the packing group than in the control group at 2 hours postoperative. The incidence of throat pain was higher in the packing group than in the control group until 2 hours postoperative. Considering the occurrence of postoperative morbidity according to the time course, pharyngeal packing during nasal surgery does not alleviate PONV but instead could aggravate postoperative throat pain. Additionally, pharyngeal packing has the possibility of airway problem such as the foreign body aspiration. Based on our results, we suggest that there is no need to place a pharyngeal pack to prevent PONV in patients undergoing nasal surgery. 1b Laryngoscope, 129:291-298, 2019.

Effect of topical ropivacaine on the response to endotracheal tube during emergence from general anesthesia: a prospective randomized double-blind controlled study

BackgroundThe airway reflex such as cough is common accompanied with severe fluctuations of hemodynamics during emergence. This prospective double-blind randomized controlled trial tested the hypothesis that topical ropivacaine may reduce extubation response and postoperative sore throat.MethodsFifty-four patients undergoing thyroidectomy were randomly assigned to two groups. The patients in Group R were received 0.75% ropivacaine, which was sprayed on the tracheal mucosa, epiglottis, tongue base, and glottis to achieve uniform surface anesthesia. As control, patients in Group C were received the same volume saline. The primiary outcome was the incidence and grade of cough during peri-extubation.ResultsThe incidence (34.62% vs. 76.92%, P = 0.002) of cough during extubation were lower in Group R compared to Group C. Meanwhile, the sore throat visual acuity score at 12 h after surgery was lower in Group R than that in Group C (2.00 vs. 3.50, P = 0.040).ConclusionTopical anesthesia with 0.75% ropivacaine before intubation can significantly reduce the incidence of cough during peri-extubation. Meanwhile, it reduced hemodynamic fluctuations and postoperative throat pain without influence patients recovery.Trial registrationChinese Clinical Trial Registry, ChiCTR1800014412 (date of registration January 2018).

An Atypical Presentation of Hemifacial Spasm Secondary to Neurovascular Compression

We conducted a prospective, randomized, controlled study to investigate the influence of pharyngeal pack placement on postoperative nausea, vomiting, and throat pain after minor oral surgery. Our study group was made up of 80 patients-45 men and 35 women, aged 19 to 52 years (mean: 27.3)-who underwent a minor oral surgical procedure under general anesthesia. Patients were randomly assigned to one of three groups: 20 patients who received a pharyngeal pack under videolaryngoscopic guidance (video guidance group), 20 who had a pack placed blindly (blind insertion group), and 40 patients who received no pack at all (control group). Postoperative nausea occurred in only 4 patients (20%) in the blind insertion group (p < 0.007). No patient experienced postoperative vomiting. Postoperative throat pain occurred in all 20 video guidance patients (100%), in 17 of the blind insertion patients (85%), and in 20 of the controls (50%). The difference between the controls and each of the two pack groups was statistically significant (p < 0.006); the difference between the two pack groups was not significant.

Use of pharyngeal packs in functional endoscopic sinus surgery: A randomized controlled trial.

To determine if pharyngeal packs have an effect on postoperative pain and postoperative nausea and vomiting in functional endoscopic sinus surgery (FESS). Forty-six patients scheduled for routine endoscopic sinus surgery were recruited into this study. The patients were randomly allocated to have or to not have pharyngeal packing prior to surgery. The placement of pharyngeal packs during FESS is controversial. Theoretically, pharyngeal packs may prevent postoperative nausea and vomiting by preventing ingestion of blood during sinus surgery. However, prior studies have not conclusively demonstrated this to be the case in FESS. Pharyngeal packs have been associated with complications including throat pain, aspiration, and death. The objective of this randomized control trial was to determine if pharyngeal packs have an effect on postoperative throat pain, nausea, and vomiting in order to determine their importance during FESS. Patients were blinded to intervention. Postoperatively, throat pain and nausea/vomiting scores were recorded. There was no significant difference in mean throat pain at 4 hours following surgery (P = 0.860). At 24 hours after surgery, patients without pharyngeal packing experienced more pain than those who had a throat pack placed (P = 0.002). There was no significant difference in the level of nausea at 4 hours after surgery (P = 0.315) or at 24 hours after surgery (P = 0.315). We recommend against the routine use of placing pharyngeal packs during FESS. 1b. Laryngoscope, 127:2460-2465, 2017.

THE EFFECT OF PERITONSILLAR INFILTRATION WITH MEPECAINE-L ON TONSILLECTOMY MORBIDITY IN ADULTS

Tonsillectomy is one of the most common performed procedures in ENT practice, it may be associated with bleeding and postoperative throat pain which are significant morbidities. The aim of this study is to evaluate the effects of peritonsillar infiltration with (Mepecaine-Levonottrdefrin) on tonsillectomy duration, intraoperative blood loss and early post-operative pain in adults. In this case-control study; fifty adults aged between 18-32 year were included, they were 34 females and 16 males who underwent tonsillectomy in the period between November 2011 and April 2012 at Basrah General Hospital, Iraq. Unilateral peritonsillar injection with Mepecaine-L (Mepecaine 2% - Levonorderfrin 1:20000) were infiltrated to one side and compared with the other side for the following parameters: operation duration, intraoperative blood loss and early post-operative pain score. There was no statically significant difference in the duration of operation between the test and control side (P>0.05); There was significant reduction in the blood loss in the tested side (P< 0.001); and also significant reduction of the early postoperative pain (P<0.001). No significant intraoperative or postoperative complications were noticed. In conclusion, the use of peritonsillar infiltration with Mepecaine-L before tonsillectomy is a safe and effective method that significantly reduces the blood loss and relieves the pain in adults after tonsillectomy. full text

Risk factors for postoperative throat pain after general anaesthesia with endotracheal intubation at the University of Gondar Teaching Hospital, Northwest Ethiopia, 2014.

IntroductionPostoperative sore throat is listed from the top as patients’ most undesirable outcome in the postoperative period. It is believed to originate from mucosal dehydration or edema, tracheal ischemia secondary to the pressure of endotracheal tube cuffs, aggressive oropharyngeal suctioning, and mucosal erosion from friction between delicate tissues and the endotracheal tube. Even if the problem was indicated in many literatures, it has never been studied in our country. The study aimed to assess prevalence and factors associated with postoperative sore throat among patients who were operated under general anesthesia with endotracheal intubation.MethodsHospital based cross sectional study was conducted from February 25 - April 10, 2014 in Gondar University hospital. Patient interview and chart review were employed for data collection. Bivariate and multivariate logistic regressions were used to determine the association.ResultsA total of 240 out of 299 patients were included in this study with a response rate of 80.3%. The prevalence of postoperative sore throat within 48 hours after operation was 59.6%. Factors which had association with postoperative sore throat from the multivariate logistic regression were female sex (AOR = 3.3, 95% CI: 1.07, 10.375), repeated number of attempts to intubate (AOR = 3.291, 95% CI: 1.658, 6.531), and the use of nasogastric tube (AOR = 0.41, 95% CI: 0.174, 0.965) respectively.ConclusionThe prevalence of postoperative sore throat was high in Gondar University Hospital. Awareness creation about the problem should be made for health professionals and postoperative sore throat management protocol need to be introduced.