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Li B, Wang M, Wang Y, Zhou L. Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta-analysis. Laryngoscope Investig Otolaryngol 2022; 7:1206-1216. [PMID: 36000068 PMCID: PMC9392395 DOI: 10.1002/lio2.835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
Objective This study was to compare tonsillectomy with intraoperative suturing (TIS) and tonsillectomy without intraoperative suturing (TsIS) in preventing postoperative tonsillectomy hemorrhage (PTH). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was followed. Articles compare TIS and TsIS in preventing PTH were included. The quality of eligible studies was assessed with the Newcastle-Ottawa Scale (NOS) by two independent investigators. Random effect models were used to determine odds ratio (OR) with 95% CIs. Results A total of 15 studies were analyzed. The pooled results showed the PTH rate was lower in the TIS group (OR = 0.64; 95% CI, 0.47-0.88). The TIS group had a lower primary and secondary PTH rate than the TsIS group with OR values of 0.44 (95% CI, 0.30-0.64) and 0.70 (95% CI, 0.54-0.90), respectively. However, suturing did not show an advantage in reducing the risk of returning to the operation room for hemostasis (OR = 0.57; 95% CI, 0.13-2.47). Adults might benefit from the intraoperative suturing procedure (OR = 0.31; 95% CI, 0.16-0.60). Patients with more than three stitches on each side had a lower PTH rate (OR: 0.44; 95% CI, 0.32-0.60). Suturing the tonsillar fossa and pillars simultaneously could reduce the PTH rate (OR = 0.47; 95% CI, 0.34-0.64). Conclusions Intraoperative suturing is a good strategy for preventing PTH. More multicenter randomized controlled studies should be conducted to demonstrate the efficacy of this procedure. Level of Evidence 5.
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Affiliation(s)
- Bo Li
- Department of Otorhinolaryngology‐Head & Neck Surgery, West China HospitalSichuan UniversityChengduChina
| | - Miaowei Wang
- Center of Rehabilitation, West China HospitalSichuan UniversityChengduChina
| | - Yanwen Wang
- West China Medical SchoolSichuan UniversityChengduChina
| | - Lingyun Zhou
- Center of Infectious Diseases, West China HospitalSichuan UniversityChengduChina
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Faramarzi M, Shishegar M, Kazemi T, Tavakolpour Saleh H, Roosta S. The effect of applying amniotic membrane on post-tonsillectomy pain and bleeding. Eur Arch Otorhinolaryngol 2020; 278:485-492. [PMID: 32601919 DOI: 10.1007/s00405-020-06173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Pain and hemorrhage are common morbidities after tonsillectomy. Although many studies have focused on post-tonsillectomy pain, inadequate researches are available on wound healing. Hence, there is a definite need for a novel technique to facilitate the healing process and thereby improving the post-tonsillectomy recovery. METHODS This prospective and randomized study was conducted on 60 adult patients who underwent tonsillectomy. They were divided into two groups of control and amniotic membrane (AM). Human amniotic membrane was applied over the tonsillar bed as a biologic dressing. Post-tonsillectomy pain and bleeding were evaluated. Also, the healing rate was assessed on days 5, 10 and 15 post-operatively. RESULTS The pain score in the AM group was lower than that in the control group during the first week after surgery (P < 0.0001). Moreover, the AM group returned faster to their normal diet in comparison with the control group (P < 0.0001). With respect to the healing rate, there were no significant differences between the groups on day 5 (P > 0.05), whereas a significant difference was seen on days 10 and 15 post-surgery (P < 0.0001). There was no significant difference between the two groups in terms of post-operative bleeding (P ≅ 1). CONCLUSION We observed that the use of AM graft as a biologic dressing might be beneficial in reducing post-operative pain and promoting the wound healing process. The results represent a further step toward developing a new technique for coverage of tonsillar fossa with sheeting or wearing grafts.
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Affiliation(s)
- Mohammad Faramarzi
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Shishegar
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Tayebeh Kazemi
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Tavakolpour Saleh
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Roosta
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Fehrm J, Borgström A, Nerfeldt P, Friberg D. Postoperative morbidity after adenotonsillectomy versus adenopharyngoplasty in young children with obstructive sleep apnea: an RCT. Eur Arch Otorhinolaryngol 2020; 277:2821-2827. [PMID: 32417961 PMCID: PMC7495989 DOI: 10.1007/s00405-020-06035-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
Purpose In our previous randomized controlled trial (RCT), comparing adenotonsillectomy (ATE) with adenopharyngoplasty (APP) in children with severe obstructive sleep apnea (OSA), there were no differences in respiratory sleep parameters or quality of life. The purpose of the present report was to evaluate postoperative morbidity from this RCT. Methods The study was a blinded RCT in 83 children (ATE = 47; APP = 36), 2–4 years of age, with an obstructive apnea–hypopnea index of ≥ 10. Pain was assessed from the first until the tenth day after surgery with a logbook that reported pain by child (FPS-R, Faces Pain Scale-Revised) and caregiver (visual analogue scale), analgesic use, return to normal diet, and weight change. Bleeding, infection, satisfaction with treatment, speech, and swallowing were assessed with a questionnaire and medical records 6 months after surgery. Results Sixty-four children (77%) returned the logbook and 65 (78%) answered the questionnaire. The median (interquartile range) day the children graded themselves as pain free (FPS-R = 0) was 7 (6–10) after ATE, compared with 9 (7 to > 10) after APP (p = 0.018). There were no other significant differences between the groups regarding any other pain-related outcomes, bleeding, infection, satisfaction, swallowing, or speech, but three children (11%) reported impaired speech after APP compared to none after ATE (p = 0.067). Conclusion The results regarding postoperative morbidity were in favor of ATE and the results from our previous report showed no advantages of APP. Therefore, APP should not be recommended in young, otherwise healthy children with OSA.
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Affiliation(s)
- Johan Fehrm
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden. .,Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Borgström
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Pia Nerfeldt
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Danielle Friberg
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Division of Otorhinolaryngology, Department of Surgical Science, Uppsala University, Uppsala, Sweden
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Evaluation of postoperative pain after tonsil-sparing styloidectomy. Eur Arch Otorhinolaryngol 2020; 277:2011-2015. [PMID: 32215739 DOI: 10.1007/s00405-020-05930-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Styloidectomy is the mainstream treatment for Eagle's syndrome when conservative treatment fails. However, the clinical efficacy of tonsil-sparing styloidectomy remains controversial. This study aimed to evaluate postoperative pain after tonsil-sparing styloidectomy in patients with Eagle's syndrome. METHODS This retrospective study enrolled 14 patients who underwent tonsil-sparing styloidectomy (TSS group) and 22 patients who underwent traditional tonsillect-styloidectomy (TTS group). Pain was evaluated using the 11-point numeric rating scale (NRS-11) at the following time points: on admission, 1 day after the operation, 3 days, postoperatively, 1 week postoperatively, 2 weeks, postoperatively, and 3 months, postoperatively. RESULTS The postoperative course was uneventful in both groups. Pain with movement was significantly reduced 3 months, postoperatively (1.28 ± 1.1), compared with the preoperative baseline level (4.78 ± 0.9) (P < 0.001). There was no significant difference in the rate at which pain decreased between the TSS group (n = 9/14; 64.3%) and the TTS group (n = 17/22; 77.3%) (P = 0.396). One week postoperatively, resting pain in the TSS group (4.36 ± 0.7) was significantly lower than that in the TTS group (5.41 ± 0.8) (P = 0.001); pain with movement in the TSS group (5.00 ± 0.8) was significantly lower than that in the TTS group (5.86 ± 0.7) (P = 0.002). Two weeks postoperatively, resting pain in the TSS group (1.14 ± 0.4) was also significantly lower than that in the TTS group (1.73 ± 0.6) (P = 0.003). CONCLUSIONS Tonsil-sparing styloidectomy is a safe and effective modality for treating Eagle's syndrome. Although there was no significant difference in surgical risk or long-term outcomes between tonsil-sparing styloidectomy and traditional tonsillect-styloidectomy, tonsil-sparing styloidectomy can alleviate perioperative pain.
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Kim JS, Kim BG, Kim DH, Hwang SH. Efficacy of pillar suture for post-tonsillectomy morbidity in children: a meta-analysis. Braz J Otorhinolaryngol 2020; 87:583-590. [PMID: 32057680 PMCID: PMC9422738 DOI: 10.1016/j.bjorl.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/10/2019] [Accepted: 12/14/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Several surgical techniques have been used during tonsillectomy to reduce complications. Objectives To assess the effects of pillar suture in conjunction with tonsillectomy as compared to tonsillectomy without suture in children. Methods Two authors independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2018. Of the included studies, we compared tonsillectomy and pillar suture in combination (suture groups) with tonsillectomy alone,without suture, (control group). Postoperative pain intensity and other morbidities (e.g., postoperative bleeding, palatal hematoma, discomfort, and pillar edema) were measured during the postoperative period. Results Postoperative bleeding [primary (OR = 0.47 [0.27; 0.81]) and secondary (OR = 0.14 [0.02; 0.78]) were significantly decreased in the pillar suture group compared to the control group. There were no significant differences between the two groups in postoperative pain at day 7 (SMD = −0.39 [−0.79; 0.00]), palatal hematoma (OR = 5.00 [0.22; 112.88]), palatal discomfort sensation (OR = 2.62 [0.60; 11.46]), site infection (OR = 5.27 [0.24; 113.35]), and velopharyngeal insufficiency (OR = 2.82 [0.11; 74.51]). By contrast, pillar edema (OR = 9.55 [4.29; 21.29]) was significantly increased in the pillar suture group compared to the control group. Conclusions Pillar suture combined with tonsillectomy may reduce postoperative bleeding incidence despite increasing pillar edema in pediatric tonsillectomy. Postoperative pain-relief, palatal hematoma, palatal discomfort sensation, site infection, and velopharyngeal insufficiency were not significantly altered compared to tonsillectomy alone. However, further studies are needed to corroborate the results of this study.
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Affiliation(s)
- Ji-Sun Kim
- The Catholic University of Korea, College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Byung Guk Kim
- The Catholic University of Korea, College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Dong-Hyun Kim
- The Catholic University of Korea, College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Se Hwan Hwang
- The Catholic University of Korea, College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seoul, Republic of Korea.
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Linxweiler M, Kühn JP, Wagner M, Al Kadah B, Schick B. Reduction of post-operative pain after tonsillectomy by a local mucosal flap - a prospective, randomized, controlled clinical trial on 100 adult patients. Acta Otolaryngol 2018; 138:913-920. [PMID: 30354838 DOI: 10.1080/00016489.2018.1497807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tonsillectomy is one of the most frequent operations in otorhinolaryngology being associated with intense post-operative pain and an impairment of swallowing and speech. AIMS To determine whether wound sealing with a local mucosal flap can improve patient rehabilitation. MATERIALS AND METHODS The study was designed as a prospective, randomized, monocentric, controlled clinical trial including 100 patients. Patients were operated on using either conventional extracapsular tonsillectomy (n = 50) or a modified technique with a local mucosal flap prepared from the posterior surface of the tonsil (n = 50). Number of requested pain medications, local oedema, patient-reported pain level, post-operative haemorrhage, impairment of speech, swallowing and general condition were assessed. The study was registered at the German Clinical Trials Register. RESULTS The mucosal flap technique significantly reduced post-operative pain [2.94 (intervention group) vs. 4.61 (control group) in an numerical analogue scale, p < .001] and the number of pain medications [6 (intervention group) vs. 1 (control group), p < .001]. CONCLUSIONS Wound sealing with a local mucosal flap can reduce post-operative pain in tonsillectomy patients and is recommended whenever anatomically feasible. SIGNIFICANCE This new tonsillectomy technique can help to reduce post-operative pain and thereby improve the patients' post-operative rehabilitation.
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Affiliation(s)
- Maximilian Linxweiler
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Centre, Homburg, Germany
| | - Jan Philipp Kühn
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Centre, Homburg, Germany
| | - Mathias Wagner
- Department of General and Surgical Pathology, Saarland University Medical Center, Homburg, Germany
| | - Basel Al Kadah
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Centre, Homburg, Germany
| | - Bernhard Schick
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Centre, Homburg, Germany
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Akcan FA, Dündar Y. Posterior pillar mucosal suspension technique for posttonsillectomy pain and wound healing: a prospective, randomized, controlled trial. Eur Arch Otorhinolaryngol 2018; 275:2879-2887. [DOI: 10.1007/s00405-018-5148-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/24/2018] [Indexed: 12/15/2022]
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Fornazieri MA, Miyazato ES, Yamamoto HM, de Lima Navarro P, de Rezende Pinna F, Voegels RL. Reducing the exposure of the tonsillar fossa does not impact postoperative pain levels in children undergoing tonsillectomy: A double-blind randomized controlled trial. Int J Pediatr Otorhinolaryngol 2018; 111:63-68. [PMID: 29958616 DOI: 10.1016/j.ijporl.2018.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is not established whether reducing the exposure of the tonsillar fossa would be an effective strategy for postoperative pain relief among the pediatric population submitted to tonsillectomy. We assessed the impact of closing this region using absorbable sutures on pain, on the resumption of normal diet and on the healing process until seven days after surgery. METHODS Randomized, double-blind, controlled trial comparing postoperative pain in 132 children between the ages of 5 and 12 years undergoing tonsillectomy having bilateral closure, unilateral closure or non-closure of the tonsillar fossa. RESULTS No differences in pain levels were reported both at discharge and on postoperative day 7. The day of resumption of normal diet was similar in all patients. Less granuloma and edema of the uvula were noted in patients with non-closure of the tonsillar fossa. CONCLUSION These results showed that reducing the exposure of the tonsillar fossa after the removal of the palatine tonsils was not an effective method for postoperative pain relief in children. Moreover, its closure was associated with slower healing.
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Affiliation(s)
- Marco Aurélio Fornazieri
- Pontifical Catholic University of Paraná, Londrina, PR, Brazil; Londrina State University, Department of Surgery, Londrina, PR, Brazil; University of São Paulo, São Paulo, São Paulo, Brazil.
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Effect of Suturation Plus Surgicel Application on Post-Tonsillectomy Bleeding and Pain. J Craniofac Surg 2018; 28:e672-e675. [PMID: 28857996 DOI: 10.1097/scs.0000000000003827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of suturation (tonsillary fossa closure) plus Surgicel application on postoperative bleeding and pain after tonsillectomies performed using a classical dissection method. STUDY DESIGN A prospective, randomized, double-blind, clinical trial was performed on 760 patients undergoing tonsillectomy or adenotonsillectomy during a 5-year period. METHODS After excluding patients with hemorrhagic disorder, chronic disease, and peritonsillar abscess, both tonsils were removed via classic dissection technique (cold knife or blunt dissection) and then electrocauterized for hemostasis. The tonsillar fossa randomly assigned to the treatment protocol (Group 1) was closed by sutures, following Surgicel application. The other side was unaltered and acted as the control (Group 2). Pain was evaluated every day for 10 days postoperatively, and bleeding was reported at any time. RESULTS A total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years (mean age 13.46 ± 7.98) were included in the study. Bleeding was observed in 31 patients: 8 from Group 1; and 23 from Group 2 (95% confidence interval [CI], P < 0.05). The average pain score was greater in Group 1 than in Group 2 on each postoperative day (95% CI, P < 0.05). CONCLUSION Suturation plus Surgicel application increased pain levels while decreasing bleeding incidence during the postoperative period.
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Review of 1078 tonsillectomy: Retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.397118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Smith D, Cheek H, Denson B, Pruitt CM. Lidocaine Pretreatment Reduces the Discomfort of Intranasal Midazolam Administration: A Randomized, Double-blind, Placebo-controlled Trial. Acad Emerg Med 2017; 24:161-167. [PMID: 27739142 DOI: 10.1111/acem.13115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Intranasal (IN) midazolam is a commonly prescribed medication for pediatric sedation and anxiolysis. One of its most frequently encountered adverse effects is discomfort with administration. While it has been proposed that premedicating with lidocaine reduces this undesirable consequence, this combination has not been thoroughly researched. The objective of our study was to assess whether topical lidocaine lessens the discomfort associated with IN midazolam administration. METHODS This was a double-blind, randomized, placebo-controlled trial performed in an urban, academic pediatric emergency department. Children 6-12 years of age who were receiving IN midazolam for procedural sedation received either 4% lidocaine or 0.9% saline (placebo) via mucosal atomizer. Subjects were subsequently given IN midazolam in a similar fashion and then rated their discomfort using the Wong-Baker FACES Pain Rating Scale (WBS). The primary endpoint of WBS score was analyzed with a two-tailed Mann-Whitney U-test, with p < 0.05 considered statistically significant. RESULTS Seventy-seven patients were enrolled over a consecutive 8-month period. One child was excluded from analysis due to a discrepancy in recording the drug identification number. Study groups were similar in regard to demographic information and indication for sedation. Subjects who received IN lidocaine reported less discomfort with IN midazolam administration (median WBS = 3, interquartile range [IQR] = 0-6) than those who received placebo (median WBS = 8, IQR = 2-9; p = 0.006). CONCLUSIONS Premedication with topical lidocaine reduces the discomfort associated with administration of IN midazolam (ClinicalTrials.gov, NCT02396537).
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Affiliation(s)
- David Smith
- Department of Pediatrics University of Alabama at Birmingham Birmingham AL
| | - Hugh Cheek
- Department of Pediatrics University of Alabama at Birmingham Birmingham AL
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García Callejo FJ, Rincón Piedrahita I, Monzó Gandía R, Sánchez Valenzuela O, Martínez Beneyto MP, Marzo Sanz M. Factors Related to Post-tonsillectomy Pain in Adults. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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García Callejo FJ, Rincón Piedrahita I, Monzó Gandía R, Sánchez Valenzuela O, Martínez Beneyto MP, Marzo Sanz M. Factors related to post-tonsillectomy pain in adults. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 67:23-32. [PMID: 25888132 DOI: 10.1016/j.otorri.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/24/2014] [Accepted: 01/07/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Assessment of factors related to pharyngeal anatomy and surgical technique as possible causes of post-tonsillectomy pain. MATERIALS AND METHODS This was a prospective observational study that included 42 patients undergoing tonsillectomy with cold and monopolar electric device dissection. We recorded duration of the entire operation, duration of electrocautery use, tonsil size and postoperative pain and discomfort assessed using a visual analogue scale (VS) and a 40-item questionnaire (QoR-40, Quality of Recovery), along with sequelae on returning to normal diet, weight loss and hospital stay. Correlations among quantitative variables were obtained by mean of lineal regression coefficients. RESULTS Duration of surgery was 22.66 ± 7.07 minutes, removing tonsils with a volume of 6046.07 ± 3866.20 mm(3) and an electrocautery use time of 66.14 ± 37.77 seconds, applying 1984.24 ± 1133.32 joules per patient. The most frequently observed Mallampati classification and tonsil size scores were stages II and III. The VS score increased and QoR-40 decreased at 24 hours and 7 days, but differences were statistically non-significant. Joule amount used for electrocautery was the parameter that correlated the best with discomfort status as measured via assessment scores, analgesic and corticosteroid requirements, weight loss and hospital stay. Pain was higher in subjects submitted to peritonsillar surgical aggression. CONCLUSIONS Improved use of electrodissection techniques, limiting and focusing the application of its energy, and preservation of peritonsillar mucosa are factors that may lower post-tonsillectomy pain levels.
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Affiliation(s)
| | - Inés Rincón Piedrahita
- Servicio de ORL, Departamento de Cirugía, Hospital Clínico Universitario, Universidad Literaria, Valencia, España
| | | | - Oscar Sánchez Valenzuela
- Servicio de ORL, Departamento de Cirugía, Hospital Clínico Universitario, Universidad Literaria, Valencia, España
| | - M Paz Martínez Beneyto
- Servicio de ORL, Departamento de Cirugía, Hospital Clínico Universitario, Universidad Literaria, Valencia, España
| | - Marta Marzo Sanz
- Servicio de ORL, Departamento de Cirugía, Hospital Clínico Universitario, Universidad Literaria, Valencia, España
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Hwang SH, Song JN, Jeong YM, Lee YJ, Kang JM. The efficacy of honey for ameliorating pain after tonsillectomy: a meta-analysis. Eur Arch Otorhinolaryngol 2014; 273:811-8. [PMID: 25524642 DOI: 10.1007/s00405-014-3433-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/05/2014] [Indexed: 11/26/2022]
Abstract
Postoperative pain and wound healing following tonsillectomy can result in dissatisfaction for the patient. However, there is no consensus on whether postoperatively administered honey effectively reduces morbidity after tonsillectomy. Therefore, a systematic review with a meta-analysis of the efficacy of honey as a treatment for postoperative pain and wound healing was performed. Two authors independently searched the database records (MEDLINE, SCOPUS, and Cochrane databases) dating from inception to June 2014. Studies comparing postoperative oral administration of honey with administration of placebo where the outcomes of interest were pain and wound healing on postoperative days were included. Baseline study characteristics, study quality, numbers of patients in steroid-treated and control groups, and treatment outcomes were extracted. Sufficient data for meta-analysis were retrieved from 4 trials with a total of 264 patients. We analyzed patient-reported pain scores and quantities of administered analgesics during the first 5 postoperative days. The pain score was significantly decreased in the honey-treated patients in comparison with the placebo-treated patients on postoperative day 1 only, but the analgesic intake of the honey-treated patients on the first 5 postoperative days was significantly less than that of the placebo-treated patients. In addition, honey significantly increased tonsillectomy bed wound healing in comparison with placebo during the first 2 weeks after surgery. This meta-analysis shows that postoperative administration of honey after tonsillectomy significantly reduces pain and promotes wound healing. Further trials comparing honey with good research methodology should be conducted to confirm these results.
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Affiliation(s)
- Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, 2 Sosa-dong, Wonmi-gu, Bucheon, Gyeonggi, 420-717, Republic of Korea
| | - Jee Nam Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, 2 Sosa-dong, Wonmi-gu, Bucheon, Gyeonggi, 420-717, Republic of Korea
| | - Yeon Min Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, 2 Sosa-dong, Wonmi-gu, Bucheon, Gyeonggi, 420-717, Republic of Korea
| | - Yeon Ji Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, 2 Sosa-dong, Wonmi-gu, Bucheon, Gyeonggi, 420-717, Republic of Korea
| | - Jun Myung Kang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, 2 Sosa-dong, Wonmi-gu, Bucheon, Gyeonggi, 420-717, Republic of Korea.
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Efficacy of ketamine in improving pain after tonsillectomy in children: meta-analysis. PLoS One 2014; 9:e101259. [PMID: 24979227 PMCID: PMC4076328 DOI: 10.1371/journal.pone.0101259] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children. SUBJECTS AND METHODS Two authors independently searched three databases (MEDLINE, SCOPUS, Cochrane) from their inception of article collection to February 2014. Studies that compared preoperative ketamine administration (ketamine groups) with no treatment (control group) or opioid administration (opioid group) where the outcomes of interest were postoperative pain intensity, rescue analgesic consumption, or adverse effects (sedation, nausea and vomiting, bad dream, worsening sleep pattern, and hallucination) 0-24 hours after leaving the operation room were included in the analysis. RESULTS The pain score reported by the physician during first 4 hours and need for analgesics during 24 hours postoperatively was significantly decreased in the ketamine group versus control group and was similar with the opioid group. In addition, there was no significant difference between ketamine and control groups for adverse effects during 24 hours postoperatively. In the subgroup analyses (systemic and local administration) regarding pain related measurements, peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity and need for analgesics. CONCLUSION Preoperative administration of ketamine systemically or locally could provide pain relief without side-effects in children undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of ketamine according to the administration methods and high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted to confirm the results of this study.
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Chiu PH, Ramar K, Chen KC, Tsai YJ, Lin CM, Chiang YC, Lu CY, Chiang RPY. Can pillar suturing promote efficacy of adenotonsillectomy for pediatric OSAS? A prospective randomized controlled trial. Laryngoscope 2013; 123:2573-7. [PMID: 23918531 DOI: 10.1002/lary.24011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/27/2012] [Accepted: 01/03/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS Pediatric obstructive sleep apnea syndrome (OSAS) is a common disorder with serious clinical implications if left untreated. The recommended initial treatment for pediatric patients with obstructive sleep apnea syndrome (OSAS) is adenotonsillectomy. However, recent reports have shown variable surgical results with adenotonsillectomy in the treatment of pediatric OSAS. STUDY DESIGN Prospective, controlled study. METHODS From April 2007 to August 2010, 24 participants were assigned alternatively to either adenotonsillectomy with pillar suturing (intervention group) or adenotonsillectomy alone (control group). RESULT The average improvement in apnea hypopnea index (AHI) was 42.6% in the control group and 79.9% in the intervention group (P=0.037). The success rate was 50% in the control group and 91.6% in the intervention group (P=0.034). Six patients (50%) in the intervention group achieved complete resolution of pediatric OSAS, as defined by an AHI <1/hour, compared to 2 patients (16.7%) in the control group (P=0.097). CONCLUSION Adenotonsillectomy with pillar suturing showed significant improvement in treating pediatric patients with OSAS compared to adenotonsillectomy alone. The procedure is simple and safe. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Po-Han Chiu
- Department of Otolaryngology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Matt BH, Krol BJ, Ding Y, Juliar BE. Effect of tonsillar fossa closure on postoperative pain and bleeding risk after tonsillectomy. Int J Pediatr Otorhinolaryngol 2012; 76:1799-805. [PMID: 23021465 DOI: 10.1016/j.ijporl.2012.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 08/27/2012] [Accepted: 09/03/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if closing the tonsil fossa after tonsillectomy leads to less pain and bleeding. STUDY DESIGN Interventional, Randomized, Single Blind, Active Control, Single Group Assignment, Safety/Efficacy Study. FOLLOW-UP 2 months. METHODS Generalized Estimating Equations (GEE) analyzed effects of tonsillar pillar closure, surgeon experience and interaction on outcomes. SETTING Primarily academic tertiary care referral center, institutional practice, primarily children, both ambulatory and hospitalized care. SUBJECTS 763 subjects (age 8-264 months) undergoing tonsillectomy. EXCLUSIONS suspected malignancy or active peritonsillar abscess. At the discretion of the attending surgeon, patients undergoing tonsillectomy during the 4 year study period were offered participation. A computer selected the side closed. 131 subjects withdrew (complete lack of follow-up information) after the first 72 h. INTERVENTION 3-0 chromic sutures on tapered needles to close one tonsillar fossa. The subject was not told which side was closed. MAIN OUTCOME MEASURES postoperative bleeding (at any time) and pain reported was sought on days 1, 7, 14, 21, and 28. RESULTS Closure of the tonsillar fossa did not change the risk of bleeding. Closing the tonsillar fossa had a 40% increase in the odds ratio of postoperative pain. In the tonsillar fossa sides left open, greater surgeon experience decreased the risk of bleeding. In closed sides, enriched surgeon experience increased the risk of bleeding (p<.0.05). CONCLUSIONS Suture closure of the tonsillar fossa after tonsillectomy does not reduce the risk of bleeding. Additionally, closing the tonsillar fossa increased postoperative pain. LEVEL OF EVIDENCE 1b (individual randomized controlled trial).
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Affiliation(s)
- Bruce H Matt
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA.
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Friedman M, Samuelson CG, Hamilton C, Maley A, Taylor D, Kelley K, Pearson-Chauhan K, Hoehne C, LeVay AJ, Venkatesan TK. Modified Adenotonsillectomy to Improve Cure Rates for Pediatric Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2012; 147:132-8. [DOI: 10.1177/0194599812440666] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare the efficacy of adenotonsillectomy (T&A) with and without pharyngoplasty (tonsillar pillar closure) in the treatment of pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS). Study Design Randomized single-blind controlled study. Setting Tertiary care center. Subjects and Methods Sixty pediatric patients with a clinical diagnosis of OSAHS presenting between January 2009 and December 2010 were enrolled and randomized to undergo either standard T&A (n = 30) or T&A with pharyngoplasty (n = 30). Surgical cure was defined as apnea-hypopnea index (AHI) <5 plus OSA-18 health-related quality-of-life (HRQL) score <60. Other outcomes included postsurgical AHI and minimum oxygen saturation (SpO2) improvement, changes in OSA-18 scores at 1 month, and postsurgical days to resume normal diet and activity. Results Three patients from each group did not undergo surgery. Of the 54 patients treated, 8 from the pharyngoplasty group and 2 from the standard group were lost to follow-up. Intention-to-treat analysis revealed no difference in cure rate between groups (standard 60%, pharyngoplasty 56.6%, P = .793). Limiting analysis to those patients with complete data, a higher, but not significantly increased, cure rate with pharyngoplasty was noted (72% vs 89.5%, P = .155). Greater OSA-18 improvement ( P = .036) and greater (although nonsignificant) AHI improvement and earlier return to normal function were noted with pharyngoplasty. Conclusion The addition of pharyngoplasty to traditional adenotonsillectomy did not significantly improve OSAHS cure rates as measured by sleep testing and HRQL, although a nonsignificant increase in cure rate was observed in those who completed the study protocol. An unexpectedly high rate of patient dropout rendered the study statistically underpowered and therefore inconclusive.
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Affiliation(s)
- Michael Friedman
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
- Rush University Medical Center, Chicago, Illinois, USA
| | - Christian G. Samuelson
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Craig Hamilton
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Alexander Maley
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
- Rush University Medical Center, Chicago, Illinois, USA
| | - David Taylor
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Kanwar Kelley
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Kristine Pearson-Chauhan
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Colleen Hoehne
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Adam J. LeVay
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - T. K. Venkatesan
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
- Rush University Medical Center, Chicago, Illinois, USA
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The efficiacy of anterior and posterior archs suturation at inferior tonsillar pole for posttonsillectomy pain control. Indian J Otolaryngol Head Neck Surg 2011; 66:115-9. [PMID: 24533369 DOI: 10.1007/s12070-011-0357-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 11/10/2011] [Indexed: 10/15/2022] Open
Abstract
The aim of our study was to investigate the efficiacy of the suturation technique after completing the tonsillectomy procedure for posttonsillectomy pain control in adult patients. August 2010-February 2011, 44 adult patients, ages ranged from 16 to 41 years old who underwent tonsillectomy at Elaziğ Training and Research Hospital Otorhinolaryngology Clinic were included to the study. After tonsillectomy procedure, anterior and posterior tonsillar archs were sutured each other and so, the area of tonsillectomy lodges which covered with mucosa were increased. Twenty two patients who applied posttonsillectomy suturation were used as study group and remnant 22 patients who did not applied posttonsillectomy suturation were used as control group. The visual analogue score (VAS) was used to evaluate the postoperative pain degree (0 no pain, 10 worst pain). ANOVA test (two ways classification with repeated measures) was used for statistical analysis of VAS values. P < 0.05 was accepted as statistically significant. The effect of time (each post-operative day) on VAS values was significant. The mean VAS values between study and control group on post-operative day 1st, 3rd, 7th, and 10th were statistically significant (P < 0.05). The severity of posttonsillectomy pain was less in study group patients than control group patients. The suturation of anterior and posterior tonsillar archs after tonsillectomy procedure was found effective to alleviate the posttonsillectomy pain in adult patients.
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Tomlinson D, von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 2010; 126:e1168-98. [PMID: 20921070 DOI: 10.1542/peds.2010-1609] [Citation(s) in RCA: 338] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
CONTEXT Numerous faces scales have been developed for the measurement of pain intensity in children. It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity, reliability, feasibility, and preference. OBJECTIVES To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility. METHODS Five major electronic databases were systematically searched for studies that used a faces scale for the self-report measurement of pain intensity in children. Fourteen faces pain scales were identified, of which 4 have undergone extensive psychometric testing: Faces Pain Scale (FPS) (scored 0-6); Faces Pain Scale-Revised (FPS-R) (0-10); Oucher pain scale (0-10); and Wong-Baker Faces Pain Rating Scale (WBFPRS) (0-10). These 4 scales were included in the review. Studies were classified by using psychometric criteria, including construct validity, reliability, and responsiveness, that were established a priori. RESULTS From a total of 276 articles retrieved, 182 were screened for psychometric evaluation, and 127 were included. All 4 faces pain scales were found to be adequately supported by psychometric data. When given a choice between faces scales, children preferred the WBFPRS. Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS. CONCLUSIONS For clinical use, we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use. For research use, the FPS-R has been recommended on the basis of utility and psychometric features. Data are sparse for children below the age of 5 years, and future research should focus on simplified measures, instructions, and anchors for these younger children.
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Affiliation(s)
- Deborah Tomlinson
- Child Health Evaluative Services, Hospital for Sick Children, Toronto, Ontario, Canada.
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