Treatment Of Post-tonsillectomy Pain Research Articles

Comparison of bupivacaine and lidocaine in the treatment of posttonsillectomy pain in pediatric patients: Our experiences

Comparison of bupivacaine and lidocaine in the treatment of posttonsillectomy pain in pediatric patients: Our experiences

Acupuncture in posttonsillectomy pain : Aprospective double-blind randomized controlled trial. German version

Postoperative swallowing pain is one of the most unpleasant after-effects of tonsillectomy. During recent years, the demand for alternatives to drug-based pain therapy has continued to grow, although the topic has received little research attention until now. A total of 46patients were randomized into verum acupuncture, control acupuncture, and drug-based treatment groups. All patients received nonsteroidal antirheumatic drugs (NSAIDs). One hour after drug intake, the verum group also received acupuncture according to classical acupuncture rules (S34, S44 and PC5). The control group had acupuncture needles placed at nonspecific acupuncture points in the midaxillary line. Acupuncture was performed by a blinded acupuncturist, who had learnt exclusively these techniques in the run up to the study. Patients were asked to evaluate their pain before, and at intervals of 20min, 1h, 2h, and 3h after drug intake/acupuncture treatment using a visual analog scale (VAS). The analgesic effect of acupuncture was significant up to 3hours in the verum group (p< 0.05). The analgesic effect in the control acupuncture group was significant for up to 1h after acupuncture (p< 0.05). With reference to the time point before acupuncture, the differences between both acupuncture groups and the drug group were significant (p< 0.01) over the whole time. Acupuncture is an effective complement to NSAIDs in the treatment of posttonsillectomy pain. Particularly patients with allergies, drug intolerance, or reduced response to the commonly administered drugs may benefit from acupuncture.

Outcomes of an Alternating Ibuprofen and Acetaminophen Regimen for Pain Relief After Tonsillectomy in Children.

To determine the outcomes of alternating doses of ibuprofen and acetaminophen in the treatment of post-tonsillectomy pain in children and to identify characteristics of children who had inadequate pain control. The medical records of children who received alternating doses of ibuprofen and acetaminophen for post-tonsillectomy pain between August 2012 and November 2013 at a tertiary care children's hospital were reviewed. Incidences of postoperative bleeding and unresolved pain were determined. A total of 583 patients (304 males, 279 females, age range=1-18 years) had received alternating doses of ibuprofen and acetaminophen after tonsillectomy and adenoidectomy. Of the 583 patients, 56 (9.6%) reported inadequate pain control. Age, sex, obesity, presence of comorbid conditions, indications for surgery, and concurrent surgical procedures were not different between children who had adequate analgesia and children who had unresolved pain. Twenty-four patients (4.1%) had postoperative bleeding. Nine patients (1.5%) required surgical intervention for bleeding. Alternating doses of ibuprofen and acetaminophen provided an effective treatment for post-tonsillectomy pain in the majority of children and did not increase rate of bleeding. Means of improving response rate to alternating doses of ibuprofen and acetaminophen merit further investigation.

Acupuncture for posttonsillectomy pain in children: a randomized, controlled study.

Surgeons have searched for the technique or medication that will produce a 'painless tonsillectomy'; however, this seems to be an impossible goal. Previous studies have shown that perioperative acupuncture may be a useful adjunct for acute postoperative pain and that acupuncture, in addition to nonsteroidal anti-inflammatory drugs, is effective in adults for the treatment of postoperative swallowing pain after tonsillectomy. Acupuncture has been shown to be safe in children. A retrospective review of acupuncture for posttonsillectomy pain in juvenile patients showed a significantly reduced pain score immediately after treatment. To examine whether acupuncture, in addition to conventional analgesic treatment, will be effective in the treatment of posttonsillectomy pain in children. We conducted a randomized, controlled, single-blinded study comparing conventional postoperative analgesic treatment with the same regime plus acupuncture to assess whether postoperative treatment of children aged 3-12years undergoing tonsillectomy with acupuncture will reduce pain and to examine possible unwanted effects of this treatment. Sixty children were recruited and randomly divided into a study group and a control group. The results indicate that in the study group, there was less pain, less analgesic drug consumption, and higher patient/parent satisfaction with analgesic treatment scores. No adverse effects were recorded. Acupuncture, in addition to conventional analgesic treatment, is an effective treatment for posttonsillectomy pain. Acupuncture is safe and well received by children and their parents.

EMG Assessment of Analgesia in Treatment of Posttonsillectomy Pain

Surface electromyographic (sEMG) study of posttonsillectomy swallow-evoked muscular reactions was performed to assess validity of EMG in evaluation of analgesic drugs. Sixty randomly chosen operated adults were divided into group 1 (n=30) treated with oxycodone, and group 2 (n=30) treated with placebo. Pain assessment included visual analog scale (VAS) pain score and EMG data: the timing, electric amplitude, and graphic patterns of muscular activity. We investigated masseter, infrahyoid, and submental-submandibular muscles. Records from trapezius muscle were used for control. The results were compared with previously established normative database. The sEMG data were compared with VAS score. Oxycodone significantly reduced VAS pain score and changed muscle reactions to analgesia (amplitude) as was recorded by sEMG, whereas placebo reduced VAS pain score nonsignificantly and changed the reaction of the trapezius muscle only. Analgesia smoothes the recorded swallow peaks and increases time of deglutition. Statistically significant difference in muscle reactions was detected between the 2 groups. sEMG might be used for quantitative evaluation of analgesic drugs by assessment of muscular reactions to pain and to analgesia. This method might add quantitative justification to the information obtained by VAS pain testing and clinical data.

Electromyographic Assessment of Dexamethasone in Treatment of Post-Tonsillectomy Pain: Randomized, Placebo-Controlled Trial

IntroductionSurface electromyographic (sEMG) study of post-tonsillectomy swallow-evoked muscular reactions was performed to assess analgesic properties of dexamethasone. MethodsSixty randomly chosen operated adults were divided into 2 groups. Group 1 (n=30) was treated with dexamethasone (Dexacort, 20mg); group 2 (n=30) was treated with placebo. Pain assessment included visual analogue scale (VAS) pain score and the EMG data such as the timing, electric amplitude and graphic patterns of muscular activity during deglutition. We investigated masseter, infrahyoid and submental-submandibular muscles. Records from trapezius muscle were used for control. The results were compared with previously established normative database. The sEMG data were compared with VAS pain score with regard to changes in clinical condition of the patients. ResultsSurface EMG signs of analgesia after tonsillectomy did not always correspond with the VAS pain score. Dexamethasone normalizes muscular activity in deglutition as detected by the EMG records. Statistically significant difference in muscle reactions was detected between the 2 groups. ConclusionIf dexamethasone is administered, the reduction of the postoperative pain could be secondary to the reduction of edema. The sEMG might be used for quantitative evaluation of analgesics via assessment of neuromuscular reactions to analgesia.

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

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

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

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