Postoperative Throat Pain Research Articles

Does Type of Pharyngeal Packing during Sinonasal Surgery Have an Effect on PONV and Throat Pain?

Postoperative nausea and vomiting (PONV) is a common problem that affects up to 30% of all surgical patients after general anaesthesia, which increases in sinonasal surgery due the very potent emetic effect of ingested blood that is swallowed during the procedures. Therefore, a hypo/oropharyngeal packing is commonly placed in an effort to prevent blood ingestion. The primary aim of this study was to compare the efficacy of 3 packing types in preventing PONV and to compare the results with patients who received no packing. The secondary aim was to compare the postoperative throat pain in all 4 groups. A prospective double-blind randomized controlled study. A university hospital. After Institutional Review Board approval and informed consent, 201 adult patients scheduled for sinonasal surgery were randomized to 4 groups to have dry packing (n = 52), packing soaked with water (n = 48), packing soaked with chlorhexidine gluconate and benzydamine hydrochloride (n = 51), or no packing (n = 50). Postoperative PONV and throat pain were assessed. Demographic data, procedural characteristics, and PONV risk scores were similar among groups. The PONV incidences, throat pain scores, and analgesic use were comparable in all 4 groups. Despite commonly used practices, usage of different types of pharyngeal packing did not affect incidence of PONV and throat pain, nor did usage of no packing.

Pre-warming the Streamlined Liner of the Pharynx Airway (SLIPA) improves fitting to the laryngeal structure: a randomized, double-blind study.

BackgroundThe Streamlined Liner of the Pharynx Airway (SLIPA), a type of supraglottic airway, has a non-inflatable cuff that softens at body temperature to fit the laryngeal structure. We investigated whether pre-warming of SLIPA to body temperature may improve insertion parameters.MethodsNinety adult patients were assigned equally randomized to either Group W or Group R. Anesthesia was induced using propofol, fentanyl, and rocuronium. In Group W, the SLIPA was warmed to 37 ° C before insertion, whereas in Group R, it was inserted at room temperature. The insertion time, oropharyngeal leak pressure, postoperative throat pain, blood staining, regurgitation, number of attempts at insertion, and difficulty of insertion were compared between the two groups.ResultsThe insertion time was shorter in Group W than in Group R (3.60 [3.15–4.06] s vs. 6.00 [4.45–7.50] s; P < 0.001). Oropharyngeal leak pressure from the time of insertion until 3 min after insertion was significantly higher in Group W than in Group R (P < 0.05). Postoperative throat pain, measured using the visual analog scale, was lower in Group W than in Group R (0.00 [0.00–2.50] vs. 2.00 [0.00–4.50]; P = 0.006). The difficulty of insertion was lower in Group W than in Group R (P < 0.004). There were no significant differences in terms of blood staining, regurgitation, and number of attempts.ConclusionsPre-warming the SLIPA to body temperature has significant benefits compared to maintaining the device at room temperature. Specifically, insertion was easier, both insertion and fitting to the laryngeal structure could be performed more quickly, and the incidence of sore throat was reduced.Trial registrationClinical Research Information Identifier NCT01209000

The influence of different usage of dyclonine hydrochloride mucilage on hemodynamics and postoperative throat pain of laryngeal mask anesthesia patients

Objective To investigate influence of different usage of dyclonine hydrochloride mucilage on hemodynamics and postoperative throat pain of laryngeal mask anesthesia patients. Methods Sixty patients in flexible ureteroscopic holmium laser lithotripsy with laryngeal mask anesthesia were randomly divided into three groups according to different usage of dyclonine hydrochloride mucilage(n=20). Group A was coated laryngeal mask with paraffin oil. Group B was coated laryngeal mask with dyclonine hydrochloride mucilage. Group C was coated laryngeal mask with dyclonine hydrochloride mucilage and dyclonine hydrochloride mucilage gargle. The indwelling time of laryngeal mask, postoperative recovery time of spontaneous breathing, time of hearing the call to open eyes, and the time of pulling out the laryngeal mask were recorded. Heart rate (HR), mean blood pressure (MBP) index at T1 (pre-anesthesia induction), T2 (1 min before pulling out the laryngeal mask), T3 (pulling out the laryngeal mask), T4 (5 min after removing the laryngeal mask ), and T5 (10 min after removing the laryngeal mask ) were recorded. The complications of throat after removing laryngeal mask were observed. The pain degree of sore-throat at the time of 30 minutes after removing the laryngeal mask was observed. The adverse reactions of the usage of dyclonine hydrochloride were observed in three groups. Results There were no statistically significant differences in indwelling time of laryngeal mask, postoperative recovery time of spontaneous breathing, time of hearing the call to open eyes, and the time of pulling out the laryngeal mask among three groups (P>0.05). There were no statistically significant differences in HR, MBP at T1,and T5 (P>0.05). HR and MBP were higher in group A than in groups B and C at T2~T4,and HR and MBP were higher in group B than in group C at T2~T4,with statistically significant difference (P 0.05). The pain degree of sore-throat in group C were significantly lower than in group B, and the pain degree of sore-throat in groups B and C was significantly lower than in group A (P<0.05). There were no allergic reactions and local anesthetic poisoning for three groups. Conclusions Dyclonine hydrochloride mucilage can reduce hemodynamic fluctuations during recovery period, and prevent or relieve effectively the patient's throat pain after laryngeal mask anesthesia. At the same time, dyclonine hydrochloride mucilage can improve the patient's postoperative physical comfort without adverse reactions, especially coated laryngeal mask with dyclonine hydrochloride mucilage and dyclonine hydrochloride mucilage gargle. Key words: Propiophenones/AD; Gels; Laryngeal masks; Hemodynamics; Anesthesia, general; Pain, postoperative/DT

Are Muscle Relaxants Needed for Nasal Intubation in Propofol and Remifentanil Anesthesia?

The authors hypothesized that a muscle relaxant would have no meaningful difference in intubation conditions during nasal intubation under remifentanil and propofol anesthesia. This parallel-group, double-blinded, randomized controlled trial included 44 patients who received saline (S group; n = 22) or rocuronium (R group; n = 22). In addition to remifentanil 0.5 μg/kg per minute and propofol 5 mg/kg per hour, propofol 0.5 mg/kg was administered until loss of consciousness. Nasal intubation was performed 10 minutes after administration of R or S 0.6 mg/kg. Significant differences in intubation conditions and salivary amylase levels before and after intubation were tested (P < .05). Vocal cord status (P = .003) and response to intubation or cuff filling (P = .008) were significantly different, but intubation conditions were not. Salivary amylase level was significantly lower with R administration (P = .022). No patient complained of postoperative throat pain and hoarseness. Muscle relaxants during nasal intubation performed after bolus administration of propofol 0.9 mg/kg in addition to 10 minutes of remifentanil 0.5 μg/kg per minute plus propofol 5 mg/kg per hour are unnecessary.

Efficacy of sucralfate for the treatment of post-tonsillectomy symptoms

Pain after tonsillectomy remains the main issue of postoperative morbidity and the search for an effective post-tonsillectomy analgesic is of increasing relevance. The aim of this study was to evaluate the effectiveness of topical sucralfate during an early post-tonsillectomy period. Fifty patients of both genders from 6 to 58 years submitted to tonsillectomy or adenotonsillectomy were randomly included into either a sucralfate treatment group (N = 25) or into a control group (N = 25). Patients of the sucralfate group received topical sucralfate four times a day for 7 days. No topical treatment was applied to patients of the control group. A systemic analgesic was standardized. Post-tonsillectomy symptoms, including throat pain, odynophagia and otalgia, were evaluated during the period of seven postoperative days. Secondary outcomes were analgesic use, well being in general, return to regular daily activities, secondary hemorrhage and side effects of sucralfate. This study revealed that during the period of the second to seventh postoperative days average throat pain scores of the sucralfate using patients were significantly lower than those of the control group patients (p < 0.05); the same could be applied to odynophagia scores during the period of all seven postoperative days (p < 0.01) and otalgia scores from the 4th postoperative day (p < 0.05). The sucralfate group patients also had a significantly smaller need for analgesics, better scores of well being in general and early return to regular daily activities with no side effects of the treatment. Topical sucralfate could be recommended for the everyday clinical practice as a safe, adjuvant medicine of treatment during the period of the first post-tonsillectomy week.

Efficacy of Dexpanthenol for Pediatric Post-Tonsillectomy Pain and Wound Healing

We evaluated the efficacy of dexpanthenol in managing pediatric post-tonsillectomy pain and wound healing and sought to discover which of two surgical tonsillectomy techniques provides better healing and less postoperative pain. One hundred twenty patients who underwent tonsillectomy were equally randomized to thermal welding and cold dissection groups. Dexpanthenol pastilles were given to half of each group. Postoperative throat pain was determined with a visual analog scale on the 1st, 3th, 7th, and 14th days, and mucosal healing patterns were assessed on the 7th and 14th days. Regardless of surgical technique, post-tonsillectomy throat pain was significantly less in the dexpanthenol groups than in the placebo groups (p < 0.05), and tonsillar wound healing was significantly better in the dexpanthenol groups than in the placebo groups (p < 0.05). When a comparison was made with regard to surgical technique, wound healing was significantly better in the cold dissection group (p < 0.05), whereas postoperative throat pain was less in the thermal welding group (p < 0.05). Postoperative administration of dexpanthenol significantly accelerates the wound healing process and decreases tonsillectomy-related pain complaints.

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

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

Analysis of pressure applied during microlaryngoscopy

Direct laryngoscopy is the most predominantly used technique in laryngology, with the fulcrum-based laryngoscope serving as the most popular instrument. The purpose of this study was to accurately calculate and measure the pressure acting on the laryngopharynx and the tongue base during microlaryngoscopy. The relationship between postoperative throat pain and the time and pressure applied during microlaryngoscopy were also investigated. Fifty patients undergoing microlaryngeal surgery were included in this prospective study. Parameters that may help predict difficult laryngeal exposure were measured in the patients before microlaryngoscopy. Using static equilibrium and the law of the lever, the pressure acting on the laryngopharynx and the tongue base were calculated and related parameters were then tested for their influence on pressure. The time and pressure applied during microlaryngoscopy of each patient were compared with postoperative throat pain grade. The mean pressure was 292 ± 109 mmHg and was significantly influenced by BMI, neck circumference and full mouth opening, whereas no gender-based differences of any kind were found. The pressure applied during microlaryngoscopy was extremely high in patients with difficult laryngeal exposure (376 ± 62 mmHg), serving as a possible reason for the presence of throat pain or complications present following surgery. However, it was found that the duration of suspension laryngoscopy, not the pressure, had the most significant correlation with postoperative throat pain.

手術用顕微鏡下に行うコブレーション口蓋扁桃摘出術

Numbers of tonsillectomies may be decreasing in Japan due to troublesome bleeding involved in managing in a small viewing field and relatively low national health insurance point for tonsillectomy. We found coblation tonsillectomy to have advantages of less bleeding, shorter operating time, and less postoprerative pain than conventional tonsillectomy. We found that 40% of those on whom a coblator was used reported no postoperative throat pain, and noted a quick learning curve in decreasing postoperative bleeding in coblation tonsillectomy.

Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial

Objective To determine the short term efficacy and safety of tonsillectomy for recurrent streptococcal pharyngitis in adults. Design Randomised controlled trial. Setting Academic referral centre in Finland. Participants 70 adults with documented recurrent episodes of streptococcal group A pharyngitis. Intervention Instant tonsillectomy (n=36) or remaining on waiting list as control (n=34). Main outcome measures Percentage change in the risk of an episode of streptococcal pharyngitis at 90 days. Rates of all episodes of pharyngitis and days with symptoms and adverse effects. Results The mean (SD) follow-up was 164 (63) days in the control group and 170 (12) days in the tonsillectomy group. At 90 days, streptococcal pharyngitis had recurred in 24% (8/34) in the control group and 3% (1/36) in the tonsillectomy group (difference 21%; 95% confidence interval 6% to 36%). The number needed to undergo tonsillectomy to prevent one recurrence was 5 (3 to 16). During the whole follow-up, the rates of other episodes of pharyngitis and days with throat pain and fever were significantly lower in the tonsillectomy group than in the control group. The most common morbidity related to tonsillectomy was postoperative throat pain (mean length 13 days, SD 4). Conclusions Adults with a history of documented recurrent episodes of streptococcal pharyngitis were less likely to have further streptococcal or other throat infections or days with throat pain if they had their tonsils removed. Trial registration Clinical Trials NCT00136877.

Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial

Objective To determine the short term efficacy and safety of tonsillectomy for recurrent streptococcal pharyngitis in adults.Design Randomised controlled trial.Setting Academic referral centre in Finland.Participants 70 adults with documented recurrent...