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Rocha LF, de Figueiredo Mello L, Silva DTE, Ferreira NSS, Salgado APF, Júnior SCG. Does pregabalin act in pain control after lateral pharyngoplasties and tonsillectomies? A pilot study. Sleep Breath 2022; 27:1107-1110. [DOI: 10.1007/s11325-022-02715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022]
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Sane S, Vash RA, Rahmani N, Talebi H, Golabi P, Kalashipour F, Heidari P, Hatami MF, Haki BK, Morwati S. Comparing the Effects of Pregabalin and Clonidine on Postoperative Pain in Tonsillectomy: A Randomized, Double-Blind, Prospective Clinical Trial. Rev Recent Clin Trials 2022; 17:RRCT-EPUB-126500. [PMID: 36154603 DOI: 10.2174/1574887117666220922092953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Tonsillectomy is one of the most common surgical procedures. This study compared the effect of Pregabalin and Clonidine on postoperative pain in adult patients undergoing elective tonsillectomy. METHODS This randomized, double-blind, prospective clinical trial was conducted among 92 patients aged 20 to 50. The clonidine group (C) was given 150 µg of clonidine tablet 90 minutes before surgery, and the pregabalin group (P) was given 300 mg of pregabalin tablet 90 minutes before surgery. The results were analyzed by SPSS 25, and statistical analysis consisted of chisquare, T-test, and χ2 tests, and a p-value less than 0.05 was considered significant. RESULTS The mean pain score and analgesic consumption scores in the pregabalin group were lower than in the clonidine group. According to the t-test, there was a significant difference between the two groups regarding pain score and analgesic consumption (p <0.05). Hemodynamic variation in both groups had no significant differences (p >0.05). CONCLUSION The present study showed that pregabalin reduced postoperative pain and analgesic consumption more effectively than clonidine.
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Affiliation(s)
- Shahryar Sane
- Department of Anesthesiology, Urmia Imam Khomeini Hospital, Urmia University of Medical Science, Urmia, Iran
| | - Rahman Abbasi Vash
- Department of Anesthesiology, Urmia Imam Khomeini Hospital, Urmia University of Medical Science, Urmia, Iran
| | - Nazila Rahmani
- College of Medical, Veterinary & Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Hadi Talebi
- Department of Medicine, Isfahan University of medical sciences, Isfahan, Iran
| | - Parang Golabi
- Department of Anesthesiology, Omid Charity Hospital, Urmia University of Medical Science, Urmia, Iran
| | - Farid Kalashipour
- Department of Operating Room, Kurdistan University of Medical Sciences, Urmia, Iran
| | - Poneh Heidari
- Department of Medicine, Urmia University of Medical Science, Urmia, Iran
| | | | - Behzad Kazemi Haki
- Department of Anesthesiology, Urmia Imam Khomeini Hospital, Urmia University of Medical Science, Urmia, Iran
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Aldamluji N, Burgess A, Pogatzki-Zahn E, Raeder J, Beloeil H. PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020; 76:947-961. [PMID: 33201518 PMCID: PMC8247026 DOI: 10.1111/anae.15299] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure‐specific efficacy as well as specific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta‐analysis guidelines with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol; non‐steroidal anti‐inflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non‐steroidal anti‐inflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra‐operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the first‐line analgesics are contra‐indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.
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Affiliation(s)
- N Aldamluji
- Department of Adult Anaesthesiology, Sidra Medicine, Qatar
| | - A Burgess
- Department of Otolaryngology Head and Neck Surgery, Com Maillot-Hartmann Private Hospital, Neuilly sur Seine, France
| | - E Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - J Raeder
- Department of Anaesthesiology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H Beloeil
- Department of Anaesthesiology and Critical Care, Université Rennes, Rennes, France
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Haddadi S, Marzban S, Parvizi A, Nemati S, Chohdari A, Atrkar Roshan Z, Ramezani H. Effects of Gabapentin Suspension and Rectal Acetaminophen on Postoperative Pain of Adenotonsillectomy in Children. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2020; 32:197-205. [PMID: 32850507 PMCID: PMC7423084 DOI: 10.22038/ijorl.2020.38811.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Adenotonsillectomy is the main treatment for symptomatic tonsillar hypertrophy with postoperative pain as the most common associated complication. The present study aimed to compare the efficacy of gabapentin with that reported for acetaminophen on the postoperative pain of adenotonsillectomy in children. Materials and Methods In this double-blind clinical trial, a total of 60 children within the age range of 7-15 years undergoing adenotonsillectomy were randomly allocated to two groups of gabapentin (n=30) and acetaminophen (n=30). The first group received a 10 mg/kg dose of gabapentin suspension preoperatively and placebo (suppository) after the intubation. The second group received a 40 mg/kg dose of acetaminophen suppository and placebo suspension simultaneous with that in the case group. Using the pain scale (based on the score of visual analog scale, prescribed drugs, dosage as well as incidence of postoperative nausea and vomiting were recorded 0, 2, 4, 6, 12, and 24 h after the surgery. The data were analyzed using SPSS software (version 22.0). A p-value less than 0.05 was considered statistically significant. Results There was no significant difference between the two groups considering the pain scores at 0, 2, 4, 6, 12, and 24 h after the surgery. In addition, the trend of pain intensity statistically decreased within 0 to 24 h in both acetaminophen (P<0.001) and gabapentin (P<0.001) groups. No statistically significant difference was observed between the two groups regarding the postoperative incidence of nausea and vomiting. Conclusion The obtained results of the present study showed that the administration of gabapentin and acetaminophen significantly reduced the postoperative pain of tonsillectomy and need for narcotics in these patients after the surgery. However, in this study, there was no particular reported superiority for any of the two groups in terms of the effects of gabapentin suspension and rectal acetaminophen.
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Affiliation(s)
- Soudabeh Haddadi
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital,Guilan University of Medical Sciences, Rasht, Iran
| | - Shideh Marzban
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital,Guilan University of Medical Sciences, Rasht, Iran
| | - Arman Parvizi
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital,Guilan University of Medical Sciences, Rasht, Iran
| | - Shadman Nemati
- Rhino-Sinus, Ear, and Skull Base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amer Chohdari
- Anesthesiologist, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkar Roshan
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital,Guilan University of Medical Sciences, Rasht, Iran
| | - Hedieh Ramezani
- Rhino-Sinus, Ear, and Skull Base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Shah AN, Moore CB, Brigger MT. Auricular acupuncture for adult tonsillectomy. Laryngoscope 2019; 130:1907-1912. [PMID: 31603582 DOI: 10.1002/lary.28338] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Adult tonsillectomy causes significant postoperative pain that can last over 14 days, but narcotic regimens only provide a modest reduction in pain. Auricular acupuncture has been demonstrated to improve pain with minimal complications. This study compared acupuncture versus control for pain, opioid consumption, nausea, and return of diet and activity following tonsillectomy. METHODS A prospective, single-blinded randomized controlled trial was performed on 134 adults undergoing tonsillectomy at a tertiary care teaching hospital. Each patient was randomized to receive either auricular (Battlefield protocol) acupuncture with auricular bandages or bandages alone while under general anesthesia. Subjects journaled daily postoperative pain, diet, activity, and opioid consumption, then returned to the clinic on postoperative day 14 for a final questionnaire and evaluation. RESULTS Ninety-nine patients completed the study with 50 patients in the acupuncture group and 49 patients in the control group. Pain scores for the acupuncture group following tonsillectomy were significantly lower than the control group on the day of surgery (2.9, 4.3; P = .01), but there was no statistically significant difference in pain thereafter. There was an equivalent level of postoperative narcotic usage, nausea, emesis, functional activity and diet between the two groups. The main complication following tonsillectomy was secondary hemorrhage and there was no significant difference between the two groups (20%, 10%; P = .13). CONCLUSION Auricular acupuncture provides increased pain relief on the day of surgery, an effect that seems to diminish after 24 hours. LEVEL OF EVIDENCE 1b Laryngoscope, 130: 1907-1912, 2020.
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Affiliation(s)
- Anil N Shah
- Department of Otolaryngology, Naval Hospital Bremerton, Bremerton, Washington, U.S.A
| | - Chad B Moore
- Nurse Anesthesia Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Matthew T Brigger
- Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California, U.S.A
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Townsend M, Liou T, Kallogjeri D, Schoer M, Scott-Wittenborn N, Lindburg M, Bottros M, Jackson RS, Nussenbaum B, Piccirillo JF. Effect of Perioperative Gabapentin Use on Postsurgical Pain in Patients Undergoing Head and Neck Mucosal Surgery: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2019; 144:959-966. [PMID: 29710075 DOI: 10.1001/jamaoto.2018.0282] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Effective postoperative pain management increases patient satisfaction, reduces cost, reduces morbidity, and shortens hospitalizations. Previous studies investigating multimodal pain therapy in otolaryngology patients focused on homogenous patient groups with short postoperative follow-up times. Objective To investigate the effect of perioperative gabapentin treatment on postsurgical pain in patients undergoing head and neck mucosal surgery. Design, Setting, and Participants Adults undergoing head and neck mucosal surgery from July 25, 2016, through June 19, 2017, were included in this double-blinded, placebo-controlled randomized clinical trial and randomized to receive gabapentin, 300 mg twice daily, or placebo before surgery and up to 72 hours after surgery. Main Outcomes and Measures Primary outcome was hourly narcotic use calculated in morphine equivalents. Secondary outcomes included subjective visual analog scale pain scores captured for resting, coughing, and swallowing using a 0- to 100-mm scale (a 100-mm line anchored with no pain on the left end and worst possible pain on the right end). A change of 10 mm or more was deemed to be clinically meaningful. Additional secondary outcome measures included degree of pain control, patient satisfaction, and adverse effects. Results Of the 110 patients randomized to receive gabapentin or placebo, 11 and 10 withdrew from each group, respectively. Ninety patients were then analyzed: 44 in the gabapentin group (mean [SD] age, 61.1 [10.0] years; 33 [75%] male; 40 [91%] white) and 46 in the placebo group (mean [SD] age, 60.9 [11.3] years; 35 [78%] male; 43 [94%] white). Both groups had similar self-reported levels of preoperative pain and narcotic effectiveness. A median difference of 0.26 mg/h of morphine (95% CI, -0.27 to 0.94 mg/h) was found between groups. After controlling for comorbidity and self-reported baseline pain levels, mixed model analysis found the difference in marginal means of visual analog scale scores between groups to be lower in the gabapentin group compared with the placebo group for all categories (rest difference, 7.9 mm; 95% CI, -0.4 to 16.2 mm; cough difference, 8.9 mm; 95% CI, -0.5 to 18.3 mm; swallow difference, 9.4 mm; 95% CI, -1.2 to 20.0 mm). More patients in the gabapentin group reported that pain was always well controlled than in the placebo group (difference, 9.2%; 95% CI, -21% to 3%). Gabapentin and placebo groups reported similar levels of satisfaction with pain control (difference, 2%; 95% CI, -11% to 15%). There was no clinically meaningful difference in reported nausea between the 2 groups (difference, 6%; 95% CI, -14% to 26%). Conclusion and Relevance Perioperative gabapentin given 300 mg twice daily did not result in reduced narcotic use, but results were compatible with clinically meaningful reductions in pain scores. Satisfaction with pain control and adverse effects were similar between groups. Trial Registration ClinicalTrials.gov Identifier: NCT02926573.
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Affiliation(s)
- Melanie Townsend
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Tina Liou
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Morgan Schoer
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nicholas Scott-Wittenborn
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Miranda Lindburg
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael Bottros
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ryan S Jackson
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri.,Editor
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Tolska HK, Hamunen K, Takala A, Kontinen VK. Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults. Br J Anaesth 2019; 123:e397-e411. [PMID: 31221427 DOI: 10.1016/j.bja.2019.04.063] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/22/2019] [Accepted: 04/05/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intense pain can last several days after tonsillectomy. It is often undertreated and improved analgesic strategies that can be safely used at home are needed. METHODS We conducted a systematic review and meta-analysis on the effectiveness of systemic medications used for post-tonsillectomy pain in adult and adolescent (13 yr old) patients. Studies were identified from PubMed, the Cochrane Library, and by hand searching reference lists from studies and review articles. Randomised, double-blind, placebo-controlled studies reporting on pain intensity or use of rescue analgesia were included. RESULTS Twenty-nine randomised controlled trials representing 1816 subjects met the inclusion criteria. Follow-up time was ≤24 h in 15 studies, in which the majority were taking nonsteroidal anti-inflammatory drugs. Thirteen studies were suitable for meta-analysis. In pooled analysis, paracetamol, dexamethasone, and gabapentinoids reduced pain intensity on the day of operation. In individual studies, ketoprofen, ibuprofen, lornoxicam, parecoxib, rofecoxib, indomethacin and dextromethorphan reduced pain intensity, need for rescue analgesics, or both on the day of operation. Oral celecoxib for 2 postoperative weeks or i.v. ketamine on the day of operation were not effective at the studied doses. Dexamethasone in multiple doses provided analgesia beyond 1 postoperative day. Pain was moderate to strong in both study and control groups during the first postoperative week. CONCLUSIONS Single analgesics and dexamethasone provide only a weak to moderate effect for post-tonsillectomy pain on the day of operation and thus a multimodal analgesic strategy is recommended. Short follow-up times and clinical heterogeneity of studies limit the usefulness of results.
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Affiliation(s)
- H K Tolska
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - K Hamunen
- National Supervisory Authority for Welfare and Health, Helsinki, Finland
| | - A Takala
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; National Supervisory Authority for Welfare and Health, Helsinki, Finland
| | - V K Kontinen
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Sanders JG, Cameron C, Dawes PJD. Gabapentin in the Management of Pain following Tonsillectomy: A Randomized Double-Blind Placebo-Controlled Trial. Otolaryngol Head Neck Surg 2017; 157:781-790. [PMID: 28741425 DOI: 10.1177/0194599817719883] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To determine if a single dose of oral gabapentin given prior to tonsillectomy decreases postoperative morbidity. Study Design Prospective randomized double-blind placebo-controlled trial. Setting Southern District Health Board University Hospitals, New Zealand, over a 10-month period. Subjects and Methods Seventy-three adults undergoing tonsillectomy were randomized to receive either a single preoperative dose of oral gabapentin (600 mg) or placebo. A standard analgesic protocol was prescribed for 14 postoperative days. The primary outcome was a patient-assigned visual analog scale pain score during rest and swallow; secondary outcomes were analgesic consumption, nausea, vomiting, and return to normal diet and activities. Complications and adverse effects were also recorded. Results Thirty-seven participants were allocated to the placebo group and 36 to the gabapentin group. After withdrawals, data were analyzed from 31 in the placebo group and 27 in the gabapentin group. Pain scores between groups were not significantly different within the first 6 hours. The gabapentin group recorded significantly higher pain scores between days 5 and 10 (maximal difference, day 8: 17.6 mm; effect size, -8.87; P = .03; 95% CI, -16.883 to -0.865). There was no significant difference in swallow pain scores or early postoperative fentanyl consumption. Consumption of paracetamol ( P = .01 at day 13 and P = .004 at day 14) and codeine ( P < .05 at days 3-5, 7, 8, 10, 14) was higher in the gabapentin group. No significant difference between groups was found for the other outcomes. Conclusions Preemptive gabapentin (600 mg) was associated with greater postoperative pain scores and analgesic consumption following adult tonsillectomy when compared with placebo.
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Affiliation(s)
- James G Sanders
- 1 Department of Otolaryngology-Head and Neck Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Claire Cameron
- 2 Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Patrick J D Dawes
- 3 Department of Surgical Science, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Sanders JG, Dawes PJD. Gabapentin for Perioperative Analgesia in Otorhinolaryngology-Head and Neck Surgery: Systematic Review. Otolaryngol Head Neck Surg 2016; 155:893-903. [PMID: 27459955 DOI: 10.1177/0194599816659042] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/14/2016] [Accepted: 06/21/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent research has investigated the role of gabapentin in perioperative pain relief in otorhinolaryngology-head and neck surgery. This review aims to identify whether sufficient evidence exists for the routine use of gabapentin in the perioperative setting. DATA SOURCES MEDLINE, Cochrane CENTRAL, EMBASE, and Google Scholar. REVIEW METHODS A comprehensive systematic search was performed with keywords for articles up to November 2015. The systematic review included all randomized, placebo-, and active-controlled trials investigating the role of perioperative gabapentin for pain in otorhinolaryngology-head and neck surgery. The studies were assessed for risk of bias and selected and reviewed by the main author. Selected trials were required to have data in the form of pain intensity scores, analgesic consumption, adverse effects, or return to normal function. RESULTS A total of 14 randomized controlled trials were included, of which 4 had an active control. The placebo-controlled trials included 4 for tonsillectomy, 3 for rhinology, and 3 for thyroidectomy. These studies were not suitable for meta-analysis. Trial quality involving gabapentin in tonsillectomy surgery is variable. The higher-quality studies reported significantly reduced analgesic consumption in the gabapentin groups, with the effect on pain scores less clear. There was a significant benefit, within the first 24 hours, in pain and analgesic consumption as compared with placebo favoring the gabapentin groups following rhinologic and thyroid surgery. CONCLUSION Overall, gabapentin appears to have a significant beneficial effect on perioperative pain relief and analgesic consumption in otorhinolaryngology-head and neck surgery procedures within the first 24 hours.
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Affiliation(s)
- James G Sanders
- Department of Otolaryngology-Head and Neck Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Patrick J D Dawes
- Department of Otolaryngology-Head & Neck Surgery, Dunedin Hospital, Dunedin, New Zealand
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Park IJ, Kim G, Ko G, Lee YJ, Hwang SH. Does preoperative administration of gabapentin/pregabalin improve postoperative nasal surgery pain? Laryngoscope 2016; 126:2232-41. [DOI: 10.1002/lary.25951] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
- In Joon Park
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, The Catholic University of Korea; Seoul Republic of Korea
| | - Geunjeon Kim
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, The Catholic University of Korea; Seoul Republic of Korea
| | - Gibeom Ko
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, The Catholic University of Korea; Seoul Republic of Korea
| | - Yeon Ji Lee
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, The Catholic University of Korea; Seoul Republic of Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, The Catholic University of Korea; Seoul Republic of Korea
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Abstract
Pediatric post-tonsillectomy analgesia continues to be highly debated and an area of active research. Tonsillectomy pain can lead to significant patient morbidity, and incur potentially avoidable healthcare costs. Moreover, the various analgesic classes, each present their own risk profiles and unique side effects when used in children post-tonsillectomy. This review delineates the clinical and pathophysiological basis for post-tonsillectomy pain, types of analgesics and their risk profiles, as well as special considerations in this clinical population and a review of alternative analgesic treatment options. This article presents a summary of recent literature and discusses evidence-based management options to aid medical and allied health professionals who may encounter these patients.
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Affiliation(s)
- Natasha Cohen
- Otolaryngology, Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Doron D Sommer
- Otolaryngology, Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
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12
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Hwang SH, Park IJ, Cho YJ, Jeong YM, Kang JM. The efficacy of gabapentin/pregabalin in improving pain after tonsillectomy: A meta-analysis. Laryngoscope 2015; 126:357-66. [PMID: 26404562 DOI: 10.1002/lary.25636] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/14/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Gabapentin and pregabalin are useful for treating neuropathic pain because of their antiallodynic and antihyperalgesic properties, which may be beneficial in managing acute postoperative pain. The goal of this meta-analysis was to perform a systematic review of the literature on the effect of gabapentinoids on postoperative pain following tonsillectomy, and its adverse effects in patients. DATA SOURCES MEDLINE, SCOPUS, and Cochrane database. METHODS Two authors independently searched the databases from their inception of article collection to May 2015. Included in the analysis were studies that compared preoperative gabapentinoid administration (gabapentinoids groups) with a placebo or pain control agent (control group) during a 24-hour postoperative period, the outcomes of interest being postoperative pain intensity; rescue analgesic consumption; or adverse effects such as sedation, nausea and vomiting, dizziness, and headache. RESULTS The pain score reported by the physician during the first 8 hours, as well as the need for analgesics during 24 hours postoperatively, were significantly decreased in the gabapentinoids group versus the control group. Additionally, there was no significant difference between gabapentinoids and control groups for adverse effect during 24 hours postoperatively. In the subgroup analyses (gabapentin and pregabalin) regarding pain-related measurements, two subgroups showed the similar effect on reducing the postoperative pain severity. CONCLUSION Preoperative administration of gabapentinoids could provide pain relief without side effects in patients undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of gabapentinoids according to the high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted in order to confirm the results of this study. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Joon Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Jin Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon Min Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Myung Kang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP. A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia 2015; 70:1186-204. [DOI: 10.1111/anae.13179] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | - J. N. Lund
- Department of Surgery; University of Nottingham; Derby UK
| | - J. P. Williams
- Department of Anaesthesia; University of Nottingham; Derby UK
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Amin SM, Amr YM. Comparison between preemptive gabapentin and paracetamol for pain control after adenotonsillectomy in children. Anesth Essays Res 2015; 5:167-70. [PMID: 25885382 PMCID: PMC4173413 DOI: 10.4103/0259-1162.94758] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Tonsillectomy is the most commonly performed surgical procedure in ENT practice. Postoperative pain remains the major problem following tonsillectomy, if not treated. Different methods and many drugs have been used to control the postoperative pain. In this study, we evaluate the role of gabapentin premedication vs paracetamol in management of postoperative pain following adenotonsillectomy in children. Materials and Methods: In a double blind randomized study, 70 children were subjected for adenotonsillectomy classified into two equal groups. Group I: Gabapentin 10 mg/kg was given orally 2 hours before induction of anesthesia (Gabapentin syrup 250 mg/5 ml); Group II: Oral paracetamol 20 mg/kg was given orally 2 hours before induction of anesthesia. All children underwent general anesthesia. Pain score was assisted postoperatively 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, and 18 hours after recovery using visual analogue scale (VAS). Result: Pain score in gabapentin group was significantly less in 2 hours, 4 hours, 6 hours, and 8 hours postoperatively than in paracetamol group (P=0.0003, <0.0001, 0.0004, <0.0001, respectively). The time to first analgesia was longer in the gabapentin group than paracetamol group (7.95±2.06 hours vs 5.85±1.87 hours; P<0.0001) and the total amount of pethedine was less in gabapentin group than in paracetamol group (8±10.05 mg vs 16.25±11.57 mg; P=0.002). Conclusion: Gabapentin premedication improves postoperative analgesia following adenotonsillectomy in children and reduce analgesic requirements in comparison with paracetamol premedication, with no reported side effects.
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Affiliation(s)
- Sabry M Amin
- Department of Anesthesia, Tanta University Hospital, Tanta University, Tanta, Egypt
| | - Yasser M Amr
- Department of Anesthesia, Tanta University Hospital, Tanta University, Tanta, Egypt
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Sun J, Wu X, Zhao X, Chen F, Wang W. Pre-emptive peritonsillar infiltration of magnesium sulphate and ropivacaine vs. ropivacaine or magnesium alone for relief of post-adenotonsillectomy pain in children. Int J Pediatr Otorhinolaryngol 2015; 79:499-503. [PMID: 25656375 DOI: 10.1016/j.ijporl.2015.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 12/14/2014] [Accepted: 01/10/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The randomized, double-blinded, placebo-controlled study evaluated the administration of local infiltration of magnesium combined with ropivacaine to reduce pain scores after pediatric adenotonsillectomy. METHODS Sixty one subjects received 5ml solution contained 0.25% ropivacaine plus 5mg/kg magnesium sulphate (Group M+R), 5ml 0.25% ropivacaine (Group R) or 5ml solution contained 5mg/kg magnesium sulphate (Group M). Pain scores in the ward and at home, analgesics received after operation and the adverse effects were recorded. RESULTS Compared with group M, patients in group M+R and group R had lower pain scores, less emergence agitation and increased time for first analgesic request. Group M+R had no benefit in reducing pain scores after adenotonsillectomy compared with group R. CONCLUSIONS Pre-emptive peritonsillar infiltration of magnesium sulphate 5mg/kg combined with 0.25% ropivacaine couldn't improve analgesia for pediatric adenotonsillectomy compared with 0.25% ropivacaine alone. However, Group M+R had less incidence of emergence agitation. Compared with group M, both of group M+R and group R had better postoperative analgesia.
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Affiliation(s)
- Jiehao Sun
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiuying Wu
- Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xiyue Zhao
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Feifei Chen
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Weijian Wang
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
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Amin SM. Evaluation of gabapentin and dexamethasone alone or in combination for pain control after adenotonsillectomy in children. Saudi J Anaesth 2014; 8:317-22. [PMID: 25191179 PMCID: PMC4141377 DOI: 10.4103/1658-354x.136417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Different methods and many drugs have been used to control the post-operative pain. In this study, we evaluate the role of gabapentin premedication and/or dexamethasone in management of post-operative pain following adenotonsillectomy in children. Materials and Methods: In a double-blind randomized study, 120 children were subjected for adenotonsillectomy classified into three equal groups. Group G: Gabapentin 10 mg/kg was given orally 2 h before induction of anesthesia (Gabapentin syrup 250 mg/5 ml. Group D: Children in this group received placebo pre-operatively and received dexamethasone 0.15 mg/kg intravenously after induction of anesthesia, but before surgery. Group C: Children in this group received combination of oral gabapentin 10 mg/kg 2 h before induction of anesthesia and intra-operative 0.15 mg/kg dexamethasone intravenously. All children underwent general anesthesia. Pain score was assisted post-operatively 2 h, 4 h, 6 h, 8 h, 12 h and 18 h after recovery using face, legs, activity, cry, consolability scale. Results: Pain score in Group C and Group G was significantly less at 4 h, 6 h and 8 h post-operatively than in Group D (P < 0.05). At 12 h, the pain score in Group C was significantly less than Group G and Group D (P < 0.05). And no significant changes were observed in pain score at 18 h post-operatively between all groups (P > 0.05). The time to first analgesia was longer in the Group C than in Group G and Group D and the time to first analgesia was significantly longer in Group G than in Group D (P < 0.05). The total amount of pethidine was less in Group C and Group G than in Group D (P < 0.05). The incidence of post-operative nausea and vomiting was statically insignificant among all groups and no reported post-operative bleeding. Conclusion: Gabapentin 10 mg/kg premedication combined with intra-operative dexamethasone 0.15 mg/kg prolongs the post-operative analgesia following adenotonsillectomy in children and decreases the amount of pethidine used post-operatively with no reported adverse effects or increase in the incidence of post-operative bleeding.
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Affiliation(s)
- Sabry Mohammad Amin
- Department of Anesthesia, Tanta University Hospital, Faculty of Medicine, Tanta 31527, Egypt
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Nesek Adam V. Comparison of Analgesic Effect between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy. ARCHIVES OF TRAUMA RESEARCH 2013; 2:99-100. [PMID: 24396804 PMCID: PMC3876549 DOI: 10.5812/atr.10117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 01/07/2013] [Accepted: 01/08/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Visnja Nesek Adam
- University Department of Anesthesiology, Resuscitation and
Intensive Care, University of Osijek, Osijek, Croatia
- Corresponding author: Visnja Nesek Adam, University
Department of Anesthesiology, Resuscitation and Intensive Care, University of Osijek,
Osijek, Croatia. Tel: +38-5913712136, Fax: +385013712111, E-mail:
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Iodice FG, Testa G. Pain Relief in Patients Undergoing Tonsillectomy. ARCHIVES OF TRAUMA RESEARCH 2013; 2:56-7. [PMID: 24396793 PMCID: PMC3876518 DOI: 10.5812/atr.10224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 02/21/2013] [Accepted: 02/24/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Francesca G Iodice
- Children's Hospital Bambino Gesù, Rome, Italy
- Corresponding author: Francesca G Iodice, Children's Hospital Bambino Gesù, Rome, Italy. Tel.: +39-3336545045, Fax: +39-3336545045, E-mail:
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Moore A. Gabapentin and post tonsillectomy pain-the next best thing? ARCHIVES OF TRAUMA RESEARCH 2013; 1:188-90. [PMID: 24396778 PMCID: PMC3876497 DOI: 10.5812/atr.9938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 12/24/2012] [Accepted: 12/29/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Albert Moore
- Department of Anaesthesia, McGill University, Montreal, Canada
- Corresponding author: Albert Moore, Department of Anaesthesia, McGill University, Montreal, Canada. Tel.: +1-5149341934 ext. 34880, Fax: +1-5148431723, E-mail:
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Yeganeh Mogadam A, Fazel MR, Parviz S. Comparison of analgesic effect between gabapentin and diclofenac on post-operative pain in patients undergoing tonsillectomy. ARCHIVES OF TRAUMA RESEARCH 2012; 1:108-11. [PMID: 24396757 PMCID: PMC3876537 DOI: 10.5812/atr.7931] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 09/14/2012] [Accepted: 09/19/2012] [Indexed: 11/16/2022]
Abstract
Background Tonsillectomy is a common procedure causing considerable postoperative pain. Postoperative pain intensity of 60 - 70 in the scale of visual analog scale (VAS) has been reported up to 3 - 4 days which could continue until 11 days after the surgery. Objectives The current study aimed to compare the analgesic effect of gabapentin and diclofenac on pain after tonsillectomy with the control group. Patients and Methods In this double-blind, placebo-controlled clinical trial, 90 patients aged 10-25 years, ASA classes I and II were randomly selected to receive 20 mg/kg oral gabapentin (n = 30), 1.0 mg / kg rectal diclofenac (n = 30) or placebo (n = 30) preoperatively. Pain was evaluated postoperatively on a visual analogue scale at 2, 6, 12 and 24 h. Opioid consumption in the first 24 h after surgery and the side effects were also recorded. Results There was no significant difference in terms of age, sex, and time of surgery in the three groups. Patients in the gabapentin and diclofenac groups had significantly lower pain scores at all-time intervals than those in the placebo group. The total meperidine consumed in the gabapentin (14.16 ± 6.97 P = 0.001) and diclofenac (16.66 ± 8.95, P = 0.004) groups was significantly less than that of the placebo (33.4 ± 13.97) group. The frequency of side effects such as vomiting, dizziness, and headache was not significantly different among the groups. Conclusions It can be concluded that gabapentin and diclofenac reduced postoperative pain and opioid consumption without obvious side effects.
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Affiliation(s)
| | - Mohammad Reza Fazel
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohammad Reza Fazel, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-9132760380, Fax: +98-3615620634, E-mail:
| | - Shohreh Parviz
- Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, IR Iran
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Mathiesen O, Jørgensen DG, Hilsted KL, Trolle W, Stjernholm P, Christiansen H, Hjortsø NC, Dahl JB. Pregabalin and dexamethasone improves post-operative pain treatment after tonsillectomy. Acta Anaesthesiol Scand 2011; 55:297-305. [PMID: 21288210 DOI: 10.1111/j.1399-6576.2010.02389.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Post-tonsillectomy pain can be severe. We investigated the analgesic effect from combinations of paracetamol, pregabalin and dexamethasone in adults undergoing tonsillectomy. METHODS In this randomized double-blind study, 131 patients were assigned to either group A (paracetamol+placebo), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). Pre-operatively, patients received either paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg or placebo according to their allocation. Post-operative pain treatment included paracetamol 1000 mg 4× and ketobemidone 2.5 mg p.n. Ketobemidone consumption, pain scores [visual analogue scale (VAS)], nausea, sedation, dizziness, number of vomits and consumption of ondansetron were recorded 2, 4 and 24 h after the operation. P<0.05 was considered statistically significant. RESULTS The mean 24-h VAS-pain score at rest was reduced in group C (P<0.003) vs. group A. The mean 24-h VAS-pain scores during swallowing were reduced in group B (P=0.009) and group C (P<0.003) vs. group A. Consumption of ketobemidone (1-4 h post-operatively) was lower in group B (P=0.003) and group C (P=0.003) vs. group A. The mean 24-h dizziness score was higher in group B (P<0.003) and C (P=0.003) vs. group A. Other parameters including re-operation for post-tonsillectomy bleeding were not different between groups. CONCLUSION Pregabalin and pregabalin+dexamethasone reduced post-operative pain scores and consumption of ketobemidone following tonsillectomy. Dizziness was increased with pregabalin.
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Affiliation(s)
- O Mathiesen
- Section of Acute Pain Management and Palliative Medicine 4114, Copenhagen University Hospital, Department of Anaesthesia 4231, Centre of Head and Orthopaedics, Copenhagen University, Rigshospitalet, Copenhagen, Denmark.
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Rectal acetaminophen versus peritonsillar infiltration of bupivacaine for postoperative analgesia after adenotonsillectomy in children. Eur Arch Otorhinolaryngol 2010; 268:581-4. [DOI: 10.1007/s00405-010-1434-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022]
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Current World Literature. Curr Opin Anaesthesiol 2010; 23:532-8. [DOI: 10.1097/aco.0b013e32833c5ccf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vayisoğlu Y, Görür K, Ozcan C, Güçlütürk T. Is speech therapy useful as a complementary treatment for post-tonsillectomy pain? Int J Pediatr Otorhinolaryngol 2010; 74:765-7. [PMID: 20398947 DOI: 10.1016/j.ijporl.2010.03.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/17/2010] [Accepted: 03/21/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the efficacy of speech therapy for relief of post-tonsillectomy pain in children. METHODS Fifty patients who underwent tonsillectomy and were randomly divided into three groups were analyzed in this study. Groups I and II received medical and speech therapy including two different phonemes group, and Group III received only medical therapy. For Group I (20 patients) soft palate phonemes and for Group II (20 patients) lips and gingival phonemes were used. The patients who received medical treatment without speech therapy were used as the control group. Postoperative pain levels were recorded with our standard visual analog scale (VAS) forms for each patient during the postoperative 10 days. The pain score of the patients were compared statistically among the three different groups. RESULTS The postoperative pain score was lower in Group I as compared to Group II (p=0.001) and III (p=0.045), and it was statistically significant. There was no significant difference regarding postoperative pain scores between Group II and Group III patients (p=0.356). CONCLUSION Speech therapy may cause to strengthen the soft palate muscles and alleviate constant post-tonsillectomy pain. This therapy may be used as a complementary treatment with standard analgesics.
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Affiliation(s)
- Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine, Mersin, Turkey.
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