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Shayan A, Berjis N, Hashemi SM. Effect of Oral Prednisolone on Pain after Tonsillectomy with Sutures: A Randomized Clinical Trial. Adv Biomed Res 2023; 12:202. [PMID: 37694239 PMCID: PMC10492605 DOI: 10.4103/abr.abr_410_22] [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: 12/03/2022] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 09/12/2023] Open
Abstract
Background Tonsillectomy, one of the most common otolaryngology surgeries, often results in postoperative complications such as pain and bleeding. Currently, there is no consensus on postoperative pain management. This study aimed to determine the efficacy of oral prednisolone on postoperative pain after tonsillectomy with sutures. Materials and Methods This pilot, double-blind, randomized clinical trial was conducted at two tertiary care centers affiliated with Isfahan University of Medical Sciences. Patients who underwent tonsillectomy with sutures were included. Participants were randomly divided into experimental and control groups. In the experimental group, patients received oral prednisolone in addition to acetaminophen; in the control group, patients received acetaminophen and a placebo. Post-operative pain was evaluated by a visual analog scale daily for ten days. Results Initially, 60 patients were enrolled in the study; however, four were excluded due to non-attendance at follow-up visits. The groups were similar in terms of age and sex (both P values >0.05). In the study, postoperative pain from 1st day to the 10th day was lower in the experimental group than in the control group (P value <0.05). Conclusion Numerous studies have been conducted on the effect of intravenous corticosteroids on this pain. However, there is no consensus on the analgesic role of oral corticosteroids for post-tonsillectomy pain. The present study showed that oral prednisolone is effective on post-operative pain compared to a placebo.
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Affiliation(s)
- Amin Shayan
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nezammedin Berjis
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mostafa Hashemi
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Malhotra V, Kumar V. Effect of Preoperative Dexamethasone on Postoperative Pain in Patients Undergoing Tonsillectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:249-254. [PMID: 37275095 PMCID: PMC10235390 DOI: 10.1007/s12070-022-03195-x] [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: 02/05/2022] [Accepted: 09/23/2022] [Indexed: 06/07/2023] Open
Abstract
Tonsillectomy is one of the most commonly performed surgical procedures worldwide. Postoperative pain remains a significant problem for patients undergoing tonsillectomy and is the most typical reason for readmission after the procedure. We conducted the present study to investigate the efficacy of a single dose of dexamethasone administered intravenously before tonsillectomy on postoperative pain in a group of patients undergoing cold dissection tonsillectomy, using a standardised anaesthetic and surgical procedure.It was a prospective study done in the Department of ENT in a tertiary care centre in eastern India, from 1 st September 2017 to 31 st August 2019 (2 years). Subjects included in the study were patients who attended the OPD of ENT of the tertiary care centre in eastern India, with a history of throat pain,difficulty in deglutition, mouth breathing, snoring. Tonsillectomy operation was recommended to the patients who fit the inclusion criteria. A hundred patients were selected for the study and divided randomly into two groups. Patients in group A (50 patients) were administered preoperative intravenous dexamethasone (0.15 mg/kg)after the induction of anaesthesia, and Group B patients (50 patients)were not administered dexamethasone along with other drugs.RESULTS: A hundred patients were enrolled after excluding the patients not fulfilling the selection criteria. The majority of patients were female, with the majority patients between 9-19 years. There was a noteworthy decreased mean pain score postoperatively of Group A on the first, third, and fifth day. (p-value = < 0.001).The results of this study suggest that a single preoperative injection of dexamethasone for patients undergoing tonsillectomy by cold dissection method significantly reduced postoperative pain.
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Affiliation(s)
- Vibhor Malhotra
- MS ENT, Otology & Hearing Implant Fellow Apollo Bannerghatta, Bangalore, India
| | - Vivek Kumar
- MS, DNB ENT, Department Of ENT PMCH, Patna, India
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Commesso EA, Osazuwa-Peters N, Frank-Ito DO, Einhorn L, Ji KSY, Greene NH, Eapen RJ, Raynor EM. Opioid and non-opioid analgesic prescribing practices for pediatric adenotonsillectomy in a tertiary care center. Int J Pediatr Otorhinolaryngol 2022; 163:111337. [PMID: 36302324 DOI: 10.1016/j.ijporl.2022.111337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/18/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
IMPORTANCE The U.S. is in an opioid epidemic with greater than 40,000 deaths annually. Pediatric adenotonsillectomy is one of the most common and painful otolaryngology surgeries performed, often associated with opioid prescriptions. OBJECTIVE To understand postoperative prescribing practices of adenotonsillectomy in a tertiary care institution and associated postoperative emergency department (ED) visits. DESIGN Descriptive analysis of retrospective cohort data. SETTING Tertiary academic healthcare institution. PARTICIPANTS Pediatric patients <18yo undergoing adenotonsillectomy between 2013 and 2016. INTERVENTIONS/EXPOSURES Postoperative analgesic regimens assessed including opioid and non-opioid analgesic prescriptions upon discharge from tonsillectomy surgery. MAIN OUTCOMES AND MEASURES Main outcomes included ED presentation within 30-days of surgery and reoperation. Secondary outcomes included reason for ED presentation and relation to prescribed analgesics. Data was analyzed between November 2021-February 2022. RESULTS 200 patients were included in the study with 69% prescribed opioids, and 51% prescribed non-opioid analgesics. Number of opioid doses ranged widely with a median of 37 (Q1, Q3: 0, 62). There were no demographic differences in patients prescribed opioids from those who were not. Of those patients who presented to the ED, 81% were not specifically prescribed acetaminophen (p < 0.001). Regression analysis models were not predictive of postoperative analgesic regimen or 30-day ED presentation (p > 0.05) CONCLUSIONS: Wide ranges of post tonsillectomy prescribing practices currently exist in our institution. Prescribing acetaminophen may help to reduce 30-day ED presentation rate. Larger prospective studies are needed to optimize pain control regimens and reduce variability of opioid prescribing practices. Standardization of postoperative pain medication doses may also reduce postoperative ED presentations.
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Affiliation(s)
- Emily A Commesso
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, 27710, USA
| | - Nosayaha Osazuwa-Peters
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, 27710, USA
| | - Dennis O Frank-Ito
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, 27710, USA
| | - Lisa Einhorn
- Duke University School of Medicine, Department of Anesthesiology, Division of Pediatrics, Durham, NC, 27710, USA
| | - Keven S Y Ji
- Oregon Health & Science University, Department of Otolaryngology-Head & Neck Surgery, Portland, OR, 97239, USA
| | - Nathaniel H Greene
- Legacy Emanuel Medical Center and Randall Children's Hospital, Portland, OR, 972272, USA
| | - Rose J Eapen
- South Bay Pediatric Otolaryngology, Manhattan Beach, CA, 90266, USA
| | - Eileen M Raynor
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, 27710, USA.
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Kubala ME, Turner M, Gardner JR, Williamson A, Richter GT. Impact of Oral Steroids on Tonsillectomy Postoperative Complications and Pain. EAR, NOSE & THROAT JOURNAL 2021; 102:NP206-NP211. [PMID: 33734886 DOI: 10.1177/01455613211000832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To analyze the impact of steroids on postoperative tonsillectomy recovery and implement findings for improvement in postoperative management. METHODS Institutional review board approved prospective study with retrospective analysis of private practice setting tonsillectomy patients (November 2015 to January 2017). A questionnaire was provided postoperatively to patients undergoing tonsillectomy with or without adenoidectomy. The study population was separated into 2 groups: patients who received steroids (3 days of either dexamethasone or prednisolone), postoperative steroid (POS), versus patients who did not receive steroids (PONS). RESULTS The questionnaire had a return rate of 27.3% (254/931). Nine of the 254 responses were disqualified for lack of information; therefore, the total number of responses was 245. Of these, 115 were POS and 130 were PONS. The groups were similar in mean age (POS: 13.2 ± 10.4 years, PONS: 14.7 ± 12.1 years, P = .32) and sex (POS: Male 40.0%, PONS: Male 40.0%, P = .97). There was an overall decrease of pain and nausea/vomiting (N/V) in the steroid group (P = .0007). There was reduction in pain (P < .05) from postoperative day (POD) 2, 3, 4, and 6 in the POS group. Otherwise, there was no significant reduction in pain from POD 7 to 14, day-by-day rate of N/V, bleeding, or rate of emergency department (ED) or clinic visit (P > .05). CONCLUSION Postoperative steroid reduced overall pain and N/V, as well as daily pain on POD 2, 3, 4, and 6. Pain from POD 7 to 14, rate of ED or clinic visit, or daily N/V and bleeding rate were not significantly different between cohorts.
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Affiliation(s)
- Michael E Kubala
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Merit Turner
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Adrian Williamson
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Otolaryngology Centers, Little Rock, AR, USA
| | - Gresham T Richter
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, AR, USA
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Noblitt BR, Siddiqui F, Iverson KC. Hemorrhage Rates in Pediatric Patients Receiving Postoperative Steroids After Tonsillectomy. Clin Pediatr (Phila) 2021; 60:20-24. [PMID: 32713183 DOI: 10.1177/0009922820944565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Importance. Developing a safe postoperative pain regimen after tonsillectomy is important. While postoperative steroids may provide an analgesic benefit, it is not known whether steroids increase the bleeding risk after tonsillectomy. Objective. To determine whether postoperative steroids increase the risk of hemorrhage after tonsillectomy in children. Design. Retrospective cohort study. Setting. Tertiary referral academic medical center. Participants. An age- and indication-matched cohort was randomly selected from tonsillectomy patients ≤12 years old from 2012 to 2017. Intervention. Prednisolone, 0.5 mg/kg (maximum dose 20 mg/day) qAM × 3 days postoperatively. Main Outcome. Postoperative hemorrhage requiring operative intervention. Results. A total of 1358 patients were included in this study, 679 of which received postoperative steroids. The steroid group had a similar of operative intervention for post-tonsillectomy hemorrhage of 1.8% versus 2.2% in the nonsteroid group (P = .560). Conclusion and Relevance. Post-tonsillectomy steroid use is not associated with an increase in operative intervention for postoperative hemorrhage.
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Greenwell AG, Isaiah A, Pereira KD. Recovery After Adenotonsillectomy-Do Steroids Help? Outcomes From a Randomized Controlled Trial. Otolaryngol Head Neck Surg 2020; 165:83-88. [PMID: 33228459 DOI: 10.1177/0194599820973250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The primary objective was to compare pain control following adenotonsillectomy (AT) in children with and without a single postoperative dose of oral dexamethasone in addition to standard analgesic medication. The secondary objective was to compare changes in caregiver-reported snoring, return to normal diet and baseline function, and the number of phone calls and emergency department (ED) visits. STUDY DESIGN Prospective randomized controlled trial. SETTING Tertiary care university hospital. METHODS Children aged 3 to 10 years with sleep-disordered breathing who were scheduled to undergo AT were randomized to receive standard analgesia with or without dexamethasone (0.6 mg/kg) administered on the third postoperative day. Standard analgesia was defined as alternating weight-based doses of ibuprofen and acetaminophen. A nurse practitioner blinded to the study condition performed telephone surveys postoperatively, and the electronic medical record was reviewed. RESULTS Enrollment comprised 149 children, of whom 119 were included. When compared with the control group (n = 61, 51%), children who received dexamethasone (n = 58, 49%) had a greater decrease in reported pain score on day 4 (mean ± SD, 2.5 ± 3.1 vs 1.1 ± 3.5, P < .001). Additionally, steroid use was associated with fewer caregiver phone calls (18 [29.5%] vs 6 [10%]) and ED visits (6 [10%] vs 1 [2%]). CONCLUSION A single dose of dexamethasone administered on day 3 after adenotonsillectomy significantly improved pain control. There were fewer phone calls and ED visits in the steroid arm. These results support the use of oral steroids as an adjunct for postoperative pain control in children undergoing AT.
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Affiliation(s)
- Ariana G Greenwell
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kevin D Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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Frelich M, Divák J, Vodička V, Bebej M, Sklienka P, Nedopílková O. Dexamethasone for postadenoidectomy pain reduction. Does it truly work? A prospective randomized double-blind clinical trial. J Clin Anesth 2020; 61:109634. [DOI: 10.1016/j.jclinane.2019.109634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
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King A, Elmaraghy C, Lind M, Tobias JD. A review of dexamethasone as an adjunct to adenotonsillectomy in the pediatric population. J Anesth 2020; 34:445-452. [PMID: 32193715 DOI: 10.1007/s00540-020-02758-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/07/2020] [Indexed: 12/22/2022]
Abstract
Although one of the most commonly performed surgical procedures in children and frequently performed as outpatient surgery, the postoperative course following tonsillectomy may include nausea, vomiting, poor oral intake, and pain. These problems may last days into the postoperative course. Although opioids may be used to treat the pain, comorbid conditions such as obstructive sleep apnea may mandate limiting the dose and the frequency of administration. Adjunctive agents may improve the overall postoperative course of patients and limit the need for opioid analgesics. Dexamethasone is a frequently administered intraoperatively as an adjunctive agent to decrease inflammation and pain, limit the potential for postoperative nausea and vomiting, and improve the overall postoperative course. The following manuscript reviews the use of dexamethasone to improve outcomes following tonsillectomy or adenotonsillectomy, discusses the controversies regarding its potential association with perioperative bleeding, and investigates options for dosing regimens which may maintain the beneficial physiologic effects while limiting the potential for bleeding.
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Affiliation(s)
- Adele King
- Department of Anesthesiology, Royal Hospital for Children, Glasgow, UK.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Charles Elmaraghy
- Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Meredith Lind
- Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. .,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
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9
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The use of steroids to reduce complications after tonsillectomy: a systematic review and meta-analysis of randomized controlled studies. Eur Arch Otorhinolaryngol 2018; 276:585-604. [DOI: 10.1007/s00405-018-5202-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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10
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Attia TM. Effect of paracetamol/prednisolone versus paracetamol/ibuprofen on post-operative recovery after adult tonsillectomy. Am J Otolaryngol 2018; 39:476-480. [PMID: 29805060 DOI: 10.1016/j.amjoto.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/09/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the effect of Paracetamol/Prednisolone versus Paracetamol/Ibuprofen on post-operative recovery after adult tonsillectomy. BACKGROUND Various analgesic protocols have been proposed for the control of post-tonsillectomy morbidity with need for better control in adult population for having higher severity of post-operative pain and risk of secondary post-tonsillectomy bleeding. METHODS This is a prospective cohort study conducted on 248 patients with age of 12 years or older distributed as two equal groups; the first one receiving Paracetamol/Prednisolone and the second one receiving Paracetamol/Ibuprofen. Both groups were compared at 7 days post-operative regarding pain at rest, tiredness of speech, dietary intake, and decrease in sleep duration. Both groups were compared regarding incidence of nausea and vomiting at 2 days post-operative. The incidence and severity of secondary post-tonsillectomy hemorrhage was compared between the two groups. RESULTS Pain at rest (no swallowing - no talking) was less in group I but not reaching statistical significance (p = 0.36). In addition, dietary intake was better in group I but not reaching statistical significance (P = 0.17). However, talking ability was better with statistically significant difference (P = 0.03) in group I. Impairment of sleep was less with group II but not reaching statistical significance (p = 0.31). The incidence of vomiting at second post-operative day was less in group I with statistical significance (p = 0.049). The incidence of secondary post-tonsillectomy bleeding was significantly higher in group II with statistical significance (p = 0.046). The severity of bleeding episodes was also significantly higher in group II (p = 0.045). CONCLUSION Both ibuprofen and prednisolone were effective as a part of post-operative medication regimen after adult tonsillectomy. However, prednisolone was superior to ibuprofen regarding improvement of pain at rest, dietary intake, tiredness of speech and post-operative nausea and vomiting. However, ibuprofen had a better impact on sleep. The incidence and severity of secondary post-tonsillectomy hemorrhage were significantly higher with ibuprofen favoring the selection of prednisolone to be combined with paracetamol in the post-operative medication protocol following tonsillectomy.
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Affiliation(s)
- Tamer M Attia
- Lecturer at Otolaryngology Department, Faculty of Medicine, Menoufia University, Egypt; Consultant at Otolaryngology, Head & Neck Surgery Department, Specialized Medical Care Hospital, Al Ain, United Arab Emirates.
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Redmann AJ, Maksimoski M, Brumbaugh C, Ishman SL. The effect of postoperative steroids on post-tonsillectomy pain and need for postoperative physician contact. Laryngoscope 2018; 128:2187-2192. [DOI: 10.1002/lary.27167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/09/2018] [Accepted: 02/12/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew J. Redmann
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati; Cincinnati Ohio
| | - Matthew Maksimoski
- Department of Otolaryngology-Head and Neck Surgery; Northwestern University; Chicago Illinois
| | - Cheryl Brumbaugh
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Ohio U.S.A
| | - Stacey L. Ishman
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati; Cincinnati Ohio
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Ohio U.S.A
- Division of Pulmonary Medicine; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
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12
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Miyamoto Y, Shinzawa M, Tanaka S, Tanaka-Mizuno S, Kawakami K. Perioperative Steroid Use for Tonsillectomy and Its Association With Reoperation for Posttonsillectomy Hemorrhage. Anesth Analg 2018; 126:806-814. [DOI: 10.1213/ane.0000000000002681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Cramer JD, Wisler B, Gouveia CJ. Opioid Stewardship in Otolaryngology: State of the Art Review. Otolaryngol Head Neck Surg 2018; 158:817-827. [DOI: 10.1177/0194599818757999] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- John D. Cramer
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brad Wisler
- Department of Anesthesiology, United States Air Force, Wright Patterson Air Force Base, Dayton, Ohio, USA
| | - Christopher J. Gouveia
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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14
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Khan S, Tumin D, King A, Rice J, Jatana KR, Tobias JD, Raman VT. Utilization of a postoperative adenotonsillectomy teaching video: A pilot study. Int J Pediatr Otorhinolaryngol 2017; 102:76-79. [PMID: 29106881 DOI: 10.1016/j.ijporl.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pediatric tonsillectomies are increasingly being performed as an outpatient procedure thereby increasing the parental role in post-operative pain management. However, it is unclear if parents receive adequate teaching regarding pain management. We introduced a video teaching tool and compared its efficacy alone and in combination with the standard verbal instruction. METHODS A prospective study which randomized parents or caregivers of children undergoing tonsillectomy ± adenoidectomy into three groups: 1) standard verbal post-operative instructions; 2) watching the video teaching tool along with standard verbal instructions or 3) video teaching tool only. Parents completed pre and post-instruction assessments of their knowledge of post-operative pain management with responses scored from 0 to 8. Telephone assessments were conducted within 48 post-operative hours with a subjective rating of the helpfulness of the video teaching tool. RESULTS The study cohort included 99 patients and their families. The median pre-instruction score was 5 of 8 points (Interquartile range [IQR]: 4, 6) and this remained at 5 following instruction. (IQR:4, 6; p = 0.702 difference from baseline). Baseline scores did not vary across the groups (p = 0.156) and there was no increase in the knowledge score from pre to post-test across the three groups. Groups B and C rated the helpfulness of the video teaching tool with a median score of 4 of 5. (IQR: 4, 5). CONCLUSIONS A baseline deficit exists in parental understanding of post-operative pain management that did not statistically improve regardless of the form post-operative instruction used (verbal vs. video-based instruction). However, the high helpfulness scores in both video groups support the use of video instruction as an alternative to or to complement to verbal instruction. However, further identification of knowledge deficits is required for optimization of post-operative educational materials.
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Affiliation(s)
- Sarah Khan
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University, Columbus, OH, USA.
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Adele King
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Julie Rice
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kris R Jatana
- Department of Otolaryngology, Nationwide Children's Hospital, Wexner Medical Center at Ohio State University, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Vidya T Raman
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
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Abstract
BACKGROUND Drugs can prevent postoperative nausea and vomiting, but their relative efficacies and side effects have not been compared within one systematic review. OBJECTIVES The objective of this review was to assess the prevention of postoperative nausea and vomiting by drugs and the development of any side effects. SEARCH METHODS We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to May 2004), EMBASE (January 1985 to May 2004), CINAHL (1982 to May 2004), AMED (1985 to May 2004), SIGLE (to May 2004), ISI WOS (to May 2004), LILAC (to May 2004) and INGENTA bibliographies. SELECTION CRITERIA We included randomized controlled trials that compared a drug with placebo or another drug, or compared doses or timing of administration, that reported postoperative nausea or vomiting as an outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted outcome data. MAIN RESULTS We included 737 studies involving 103,237 people. Compared to placebo, eight drugs prevented postoperative nausea and vomiting: droperidol, metoclopramide, ondansetron, tropisetron, dolasetron, dexamethasone, cyclizine and granisetron. Publication bias makes evidence for differences among these drugs unreliable. The relative risks (RR) versus placebo varied between 0.60 and 0.80, depending upon the drug and outcome. Evidence for side effects was sparse: droperidol was sedative (RR 1.32) and headache was more common after ondansetron (RR 1.16). AUTHORS' CONCLUSIONS Either nausea or vomiting is reported to affect, at most, 80 out of 100 people after surgery. If all 100 of these people are given one of the listed drugs, about 28 would benefit and 72 would not. Nausea and vomiting are usually less common and, therefore, drugs are less useful. For 100 people, of whom 30 would vomit or feel sick after surgery if given placebo, 10 people would benefit from a drug and 90 would not. Between one to five patients out of every 100 people may experience a mild side effect, such as sedation or headache, when given an antiemetic drug. Collaborative research should focus on determining whether antiemetic drugs cause more severe, probably rare, side effects. Further comparison of the antiemetic effect of one drug versus another is not a research priority.
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Affiliation(s)
- John Carlisle
- Torbay Hospital, South Devon Healthcare NHS Foundation TrustDepartment of AnaestheticsLawes BridgeTorquayDevonUKTQ2 7AA
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16
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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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Aveline C, Le Hetet H, Le Roux A, Bonnet F. A survey of the administration of prednisolone versus ibuprofen analgesic protocols after ambulatory tonsillectomy. Anaesth Crit Care Pain Med 2015; 34:281-7. [DOI: 10.1016/j.accpm.2014.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/10/2014] [Indexed: 10/22/2022]
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Park SK, Kim J, Kim JM, Yeon JY, Shim WS, Lee DW. Effects of oral prednisolone on recovery after tonsillectomy. Laryngoscope 2014; 125:111-7. [PMID: 25291409 DOI: 10.1002/lary.24958] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/10/2014] [Accepted: 09/15/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the effect of oral prednisolone on recovery from tonsillectomy. STUDY DESIGN Prospective, randomized, controlled trial of 198 consecutive patients, aged 4 years and older, with no previous or known contraindications to steroid therapy. METHODS All 198 patients scheduled for elective tonsillectomy with or without adenoidectomy from April 2013 to April 2014 were included. The participants were then randomly assigned to receive a postoperative course of prednisolone 0.25 mg/kg/d or no prednisolone over 7 days. During the first postoperative day, pain, type of diet (none, fluid, soft, normal), type of activity (none, bed rest, quiet, restricted, normal), presence of nausea and vomiting, postoperative bleeding rate, and sleep disturbance were assessed using questionnaires. All patients were followed up on days 7 and 14 by endoscopic photographic examination of both tonsillar fossa and by completion of questionnaires. RESULTS No statistically significant differences in pain, diet, activity, rate of minor bleeding, nausea/vomiting, fever, or sleep disturbance were observed between the groups on day 1. On day 7, however, in pediatric patients, differences in pain (P = .001), diet (P = .001), activity (P = .004), mean area of re-epithelialization (P = .000), fever (P = .04), and sleep disturbance (P = .04) were observed. On day 14, differences in the mean area of re-epithelialization (P = .000, .001) remained in both pediatric and adult patients. CONCLUSIONS Oral prednisolone may be beneficial during recovery from tonsillectomy without causing any serious complications.
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Affiliation(s)
- Soo K Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
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Pre-emptive peritonsillar dexamethasone vs. levobupivacaine infiltration for relief of post-adenotonsillectomy pain in children: a controlled clinical study. Int J Pediatr Otorhinolaryngol 2014; 78:1467-71. [PMID: 24984928 DOI: 10.1016/j.ijporl.2014.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the effects of the pre-emptive local infiltration of dexamethasone vs. levobupivacaine on postoperative pain and morbidity in pediatric adenotonsillectomy patients. METHODS A total of 60 patients (32 males and 28 females), aged 3-14 years, were included in this double-blind prospective randomized controlled clinical study from September of 2011 until May of 2012. Patients admitted for adenotonsillectomies after informed consent was obtained from the parents, and randomized into three groups receiving either dexamethasone sodium phosphate (Group 1, mean age 5.9 ± 1.6), levobupivacaine with epinephrine (Group 2, mean age 6.1 ± 2.6), or saline (Group 3, mean age 6.0 ± 3.4). Pain scores at the 1st, 4th, 8th, 12th, 16th, and 20th hours, and first, second, third and seventh days post-operatively were recorded by the parents using McGrath's face scale. The operation type, operation time and anesthesia time, the time of the first request for postoperative analgesia, and the total number of analgesic interventions were recorded. RESULTS Pain scores were revealed in this order: Group 1 (steroid) < Group 2 (levobupivacaine) < Group 3 (saline) at all times (p = 0.000). The anesthesia times for Group 1 and Group 2 were different (steroid vs. levobupivacaine), and the time to first analgesic was longer in Groups 1 (steroid) and 2 (levobupivacaine) than in Group 3 (saline) (p < 0.000). The total number of analgesic interventions was lower in Group 1 (steroid) than in Group 2 (levobupivacaine) and Group 3 (saline) (steroid vs. saline, p = 0.000, and steroid vs. levobupivacaine, p < 0.05). CONCLUSION Peritonsillar dexamethasone infiltration was more effective than both levobupivacaine and saline in reducing post-tonsillectomy pain. It was proven to be a safe and effective method.
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Constant I, Ayari Khalfallah S, Brunaud A, Deramoudt V, Fayoux P, Giovanni A, Mareau C, Marianowski R, Michel J, Mondain M, Paganelli A, Pondaven S, Schultz P, Treluyer JM, Wood C, Nicolas R. How to replace codeine after tonsillectomy in children under 12 years of age? Guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:233-8. [PMID: 25106698 DOI: 10.1016/j.anorl.2014.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/10/2014] [Indexed: 01/03/2023]
Abstract
The authors present the guidelines of the French Oto-rhino-laryngology--Head and Neck Surgery Society (SFORL) regarding pain management in children and adults following tonsillectomy. A multidisciplinary work group was entrusted with a literature review. Guidelines were drawn up based on the articles retrieved and the group members' experience. They were read over by an editorial group independent of the work group. A coordination meeting drew up the final version. Guidelines were graded A, B or C or as professional agreement in decreasing order of level of evidence. At home, non-steroid anti-inflammatory drugs (NSAIDs) are recommended in association with paracetamol in elevated respiratory risk and especially obstructive sleep apnea syndrome; in elevated hemorrhagic risk (hemostasis disorder, surgical problems, etc.), tramadol is recommended. Two other treatment schedules (modified NSAIDs and corticosteroids) have not undergone dedicated study and should be assessed. Management of post-tonsillectomy pain in children is founded on individual risk/benefit analysis.
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Affiliation(s)
- I Constant
- Service d'anesthésie réanimation, hôpital Armand-Trousseau, 26, avenue du docteur-Netter, 75012 Paris, France.
| | - S Ayari Khalfallah
- Service d'ORL, chirurgie cervico-faciale et audiophonologie, HCL Groupement Hospitalier Est, hôpital Femme-Mère-Enfant (BRON), 59, boulevard Pinel, 69677 Bron cedex, France
| | - A Brunaud
- Cabinet d'ORL, centre médical Alpha 128, 128, avenue des Champs-Lasniers, 91940 Les Ulis, France
| | - V Deramoudt
- Service ORL et chirurgie cervico-faciale, hôpital Pontchaillou, CHU de Rennes, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - P Fayoux
- Service ORL et consultation chirurgique pédiatrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille, France
| | - A Giovanni
- Service ORL et chirurgie cervico-faciale, CHU Timone, 264, rue St-Pierre, 13385 Marseille cedex, France
| | - C Mareau
- Centre de la douleur chronique, CHU La Timone, 264, rue St-Pierre, 13385 Marseille cedex, France
| | - R Marianowski
- Service ORL et chirurgie cervico-faciale, CHRU de Brest, 5, avenue Foch, 29200 Brest, France
| | - J Michel
- Service ORL et chirurgie cervico-faciale, CHU Timone, 264, rue St-Pierre, 13385 Marseille cedex, France
| | - M Mondain
- Service ORL et chirurgie cervico-faciale, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - A Paganelli
- Service ORL et chirurgie cervico-faciale, CHU Timone, 264, rue St-Pierre, 13385 Marseille cedex, France
| | - S Pondaven
- Service ORL et chirurgie cervico-faciale pédiatrique, hôpital Clocheville, boulevard Beranger, 37000 Tours, France
| | - P Schultz
- Service ORL et chirurgie cervico-faciale, CHU Hautepierre, 1, avenue Maline, 67098 Strasbourg, France
| | - J M Treluyer
- Faculté et université Paris Descartes, rue de l'école-de-medecine, 75006 Paris, France
| | - C Wood
- Centre de prise en charge de la douleur chronique, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - R Nicolas
- Service ORL et chirurgie cervico-faciale, CHU Timone, 264, rue St-Pierre, 13385 Marseille cedex, France
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The effects of dexamethasone and levobupivacaine on postoperative pain in Modified Radiofrequency Assisted Uvulopalatoplasty (MRAUP) surgery. Eur Arch Otorhinolaryngol 2013; 271:1803-8. [DOI: 10.1007/s00405-013-2859-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 12/04/2013] [Indexed: 11/26/2022]
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Plante J, Turgeon AF, Zarychanski R, Lauzier F, Vigneault L, Moore L, Boutin A, Fergusson DA. Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: systematic review and meta-analysis of randomised controlled trials. BMJ 2012; 345:e5389. [PMID: 22930703 PMCID: PMC3429364 DOI: 10.1136/bmj.e5389] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the risk of postoperative bleeding and reintervention with the use of systemic steroids in patients undergoing tonsillectomy. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, Cochrane Library, Scopus, Web of Science, Intute, Biosis, OpenSIGLE, National Technical Information Service, and Google Scholar were searched. References from reviews identified in the search and from included studies were scanned. REVIEW METHODS Randomised controlled trials comparing the administration of systemic steroids during tonsillectomy with any other comparator were eligible. Primary outcome was postoperative bleeding. Secondary outcomes were the rate of admission for a bleeding episode, reintervention for a bleeding episode, blood transfusion, and mortality. RESULTS Of 1387 citations identified, 29 randomised controlled trials (n=2674) met all eligibility criteria. Seven studies presented a low risk of bias, but none was specifically designed to systematically identify postoperative bleeding. Administration of systemic steroids did not significantly increase the incidence of post-tonsillectomy bleeding (29 studies, n=2674 patients, odds ratio 0.96 (95% confidence interval 0.66 to 1.40), I²=0%). We observed a significant increase in the incidence of operative reinterventions for bleeding episodes in patients who received systemic steroids (12, n=1178, 2.27 (1.03 to 4.99), I²=0%). No deaths were reported. Sensitivity analyses were consistent with the findings. CONCLUSIONS Although systemic steroids do not appear to increase bleeding events after tonsillectomy, their use is associated with a raised incidence of operative reinterventions for bleeding episodes, which may be related to increased severity of bleeding events. Systemic steroids should be used with caution, and the risks and benefits weighed, for the prevention of postoperative nausea and vomiting after tonsillectomy before further research is performed to clarify their condition of use.
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Affiliation(s)
- Jennifer Plante
- Department of Anesthesiology, Division of Critical Care Medicine, Université Laval, Centre Hospitalier Affilié Universitaire de Québec, Enfant-Jésus Hospital, Québec City, QC, Canada G1J 1Z4
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Macassey E, Dawes P, Taylor B, Gray A. The effect of a postoperative course of oral prednisone on postoperative morbidity following childhood tonsillectomy. Otolaryngol Head Neck Surg 2012; 147:551-6. [PMID: 22585378 DOI: 10.1177/0194599812447776] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Tonsillectomy is a common procedure with a wide range of described operative techniques and usage of perioperative medications. Single-dose intraoperative dexamethasone has been shown to decrease postoperative nausea and pain and improve return to normal diet. The aim was to determine if a course of oral postoperative steroids would further decrease postoperative morbidity following tonsillectomy in children. STUDY DESIGN Randomized, placebo-controlled, double-blinded trial. Power analysis recommended 198 participants. SETTING A university hospital and private hospital. SUBJECTS AND METHODS The authors compared a 5-day course of oral prednisolone with placebo in a pediatric population (3-16 years) undergoing tonsillectomy to assess effects on postoperative pain, nausea, and vomiting and return to normal function. They also assessed the effect of corticosteroids on sleep duration and aspects of sleep quality. RESULTS The results showed no significant difference between the 2 groups when analyzed for differences in the above variables both overall and at each of the postoperative 10 time points (pain, P = .478; nausea and vomiting, P = .556; return to normal diet well, P = .234; return to normal activity, P = .668; bedtime, P = .056; number of times awake during the night, P = .593). CONCLUSION There is no evidence of benefit from postoperative administration of corticosteroids in pediatric patients recovering from tonsillectomy.
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Affiliation(s)
- Emily Macassey
- Department of Otolaryngology, Head and Neck Surgery, Dunedin Public Hospital, Dunedin, New Zealand
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Abstract
BACKGROUND This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2003.Tonsillectomy continues to be one of the most common surgical procedures performed worldwide. Despite advances in anesthetic and surgical techniques, post-tonsillectomy morbidity remains a significant clinical problem. OBJECTIVES To assess the clinical efficacy of a single intraoperative dose of dexamethasone in reducing post-tonsillectomy morbidity. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN; and additional sources for published and unpublished trials. The date of the most recent search was 29 October 2010, following a previous search in September 2002. SELECTION CRITERIA Randomized, double-blind, placebo-controlled trials of a single dose of intravenous, intraoperative corticosteroid for pediatric patients (age < 18 years) who underwent tonsillectomy or adenotonsillectomy. DATA COLLECTION AND ANALYSIS The first author extracted data regarding the primary outcome measures and measurement tools from the published studies. The first author also recorded data regarding study design, patient ages, procedures performed, dose of corticosteroid and method of delivery, as well as methodological quality. When data were missing from the original publications, we contacted the authors for more information. We performed data analysis with a random-effects model, using the RevMan 5.1 software developed by the Cochrane Collaboration. MAIN RESULTS We included 19 studies (1756 participants). We selected only randomized, placebo-controlled, double-blinded studies to minimize inclusion of poor quality studies. However, the risk of bias in the included studies was not formally assessed. Children receiving a single intraoperative dose of dexamethasone (dose range = 0.15 to 1.0 mg/kg) were half as likely to vomit in the first 24 hours compared to children receiving placebo (risk ratio (RR) 0.49; 95% confidence interval (CI) 0.41 to 0.58; P < 0.00001). Routine use in five children would be expected to result in one less patient experiencing post-tonsillectomy emesis (risk difference (RD) -0.24; 95% CI -0.32 to -0.15; P < 0.00001). Children receiving dexamethasone were also more likely to advance to a soft/solid diet on post-tonsillectomy day one (RR 1.45; 95% CI 1.15 to 1.83; P = 0.001) than those receiving placebo. Finally, postoperative pain was improved in children receiving dexamethasone as measured by a visual analog scale (VAS, 0 to 10) (MD -1.07; 95% CI -1.73 to -0.41; P = 0.001), which correlates clinically to a reduction in pain (on a VAS of 0 to 10) from 4.72 to 3.65. No adverse events were noted in the included studies. AUTHORS' CONCLUSIONS The evidence suggests that a single intravenous dose of dexamethasone is an effective, safe and inexpensive treatment for reducing morbidity from pediatric tonsillectomy.
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Affiliation(s)
- David L Steward
- University of Cincinnati College of MedicineOtolaryngology ‐ Head and Neck Surgery231 Sabin WayML 0528 ‐ Dept of OTO‐HNSCincinnatiUSA45267‐0528
| | - Jedidiah Grisel
- University of Cincinnati Academic Health CenterDepartment of Otolaryngology231 Albert Sabin WayCincinnatiUSA45267
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Yoruk O, Akgun M, Sutbeyaz Y, Aktan B, Ucuncu H, Tatar A, Altas E, Araz O, Erdem AF. Treatment of primary snoring using modified radiofrequency-assisted uvulopalatoplasty. Eur Arch Otorhinolaryngol 2009; 266:1807-14. [DOI: 10.1007/s00405-009-0926-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 02/10/2009] [Indexed: 11/24/2022]
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The effect of preoperative fasting on postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy. Int J Pediatr Otorhinolaryngol 2009; 73:263-73. [PMID: 19062107 DOI: 10.1016/j.ijporl.2008.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 10/16/2008] [Accepted: 10/21/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this prospective randomized study was to examine whether active counseling and more liberal oral fluid intake decrease postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy. METHODS Families, whose child was admitted for ambulatory tonsillectomy or adenotonsillectomy, were randomly assigned to the study groups (n=116; 58 families in each group). The intervention group received the fasting instructions with face-to-face counseling for the child's active preoperative nutrition, and the control group the fasting instructions according to the hospital's standard procedure. The level of postoperative pain and nausea was scored in the postanesthesia care unit (PACU) during the first postoperative hour, as well as at 2, 4, 8 and 24h postoperatively. The first scoring in PACU was performed by the attending nurse with a 0-10 scale. The rest of the estimations were made independently and simultaneously by the children using a VAS scale, and by the parents using a 0-10 scale. RESULTS The children in the control group were in more pain in the PACU than the children in the intervention group, and the difference between the groups was statistically significant (p=0.0002). All pain scores, according to the children and the parents, increased after the surgery. In both groups the highest score values were found at home 8h after surgery, and no significant difference was found between the study groups. On the first postoperative morning, the children in the control group were in pain (p=0.047). The children did not have significant nausea in the PACU, but the nausea increased postoperatively. Four hours after surgery the children were most nauseous according to all estimations (60%, n=116). More than half of the children vomited and most vomited clotted blood. Nausea and vomiting decreased during the evening of the surgery, but six children vomited the next morning, four of them vomited blood. The incidence and intensity of postoperative nausea and vomiting between the intervention and control groups were not statistically significant. However, preoperative nutritional counseling and more liberal per oral fluid intake appeared to have a positive effect on the children's well-being and helped them to better tolerate postoperative nausea and vomiting. CONCLUSIONS The preoperative counseling about active preoperative nutrition significantly reduces the child's pain during the first posttonsillectomy hours and might prepare the child to better tolerate the stress of potential postoperative nausea and vomiting.
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Antibiotic use in post-adenotonsillectomy morbidity: a randomized prospective study. Braz J Otorhinolaryngol 2008; 74:337-41. [PMID: 18661005 PMCID: PMC9442118 DOI: 10.1016/s1808-8694(15)30565-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Accepted: 04/15/2007] [Indexed: 11/21/2022] Open
Abstract
Tonsillectomy with or without adenoidectomy still is one of the most commonly performed surgical procedures in the world, mostly in the pediatric population. Aim to study the impact of amoxicillin for 7 days in post-adenotonsillectomy recovery, comparing results with a control group. Study type: prospective, randomized, controlled study with 120 patients. Patients and Methods the patients were randomized according to surgery time to receive 7 days of amoxicillin associated with pain killers, or analgesic alone. During the first week of postoperative, we assessed the level of pain, oral intake acceptance, nausea and vomits, fever and return to daily activities. Results It was only in the fourth postoperative day that the group receiving antibiotic agents showed a statistically significant difference as far as pain is concerned. There was no difference between the two groups for other data analyzed. Conclusion considering the results from our study and reviewing the literature on the use of antibiotic agents, we agree that there is no improvement in patient recovery after adenotonsillectomy with the use of amoxicillin for 7 days in the postoperative.
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Guerra MM, Garcia E, Pilan RRDM, Rapoport PB, Campanholo CB, Martinelli EO. Avaliação da antibioticoterapia na morbidade pós-adenotonsilectomia: estudo prospectivo randomizado. ACTA ACUST UNITED AC 2008. [DOI: 10.1590/s0034-72992008000300005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A tonsilectomia, associada ou não à adenoidectomia, continua a ser um dos procedimentos cirúrgicos mais realizados mundialmente, incidindo principalmente sobre a população pediátrica. OBJETIVO: Investigar o impacto do uso da amoxacilina por 7 dias na recuperação pós adenoamigdalectomia, comparando os resultados com um grupo controle. Tipo de Estudo: Estudo prospectivo randomizado controlado com 120 pacientes. PACIENTES E MÉTODO: Os pacientes foram randomizados ao tempo da cirurgia para receber um curso de 7 dias de amoxacilina associada a analgésicos ou apenas analgésicos. Durante a primeira semana de pós-operatório foram avaliados o grau de dor, aceitação da via oral, náuseas e vômitos, febre e retorno às atividades. RESULTADOS: Somente no 4º pós-operatório o grupo recebendo antibiótico teve uma diferença estatística significante no grau de dor. Não houve diferença entre os dois grupos para outros dados analisados. CONCLUSÃO: Considerando os resultados do nosso estudo e revisando a literatura sobre o uso de antibióticos, nós concordamos que não há nenhuma melhora na recuperação dos pacientes submetidos à adenoamigdalectomia após o uso de amoxicilina por 7 dias.
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The use of dexamethasone to reduce pain after tonsillectomy in adults: a double-blind prospective randomized trial. Laryngoscope 2008; 118:232-6. [PMID: 18043492 DOI: 10.1097/mlg.0b013e318159a5cc] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the effectiveness of dexamethasone to reduce pain after tonsillectomy in adults by at least 13 mm on the visual analogue scale. The secondary objective was to reduce the use of narcotics by at least 20%. STUDY DESIGN This multicentric study is a prospective double-blind randomized controlled trial. METHODS A total of 102 patients were enrolled and received a 4-day trial either of dexamethasone in decreasing doses or placebo. The patients were asked to note the level of pain on the visual analogue scale daily for 7 days. They also had to record their consumption of analgesic and any eventual side effects. RESULTS There were no statistically or clinically significant differences between the two groups for the level of pain noted on the visual analogue scale for the first 4 and 7 days. There were no statistical differences for the consumption of hydromorphone between the two groups. CONCLUSION We cannot recommend the use of dexamethasone on a routine basis following tonsillectomy in adults for the reduction of pain or narcotics consumption.
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Abstract
BACKGROUND Of the morbidities that follow tonsillectomy, nausea and vomiting, fever, pain and inadequate oral intake are the most commonly encountered. The incidence of postoperative nausea and vomiting (PONV) has been reported as between 40% and 85%. In children, the risk of dehydration is increased owing to the delay in oral intake of fluids in the early postoperative period. In efforts to reduce postoperative morbidity, numerous modifications and adjuncts to the surgical procedure have been suggested, including the use of steroids. PATIENTS AND METHODS Reduction in PONV, pain and early return to a normal diet were studied as separate end-points in a review of the current literature. RESULTS A total of 31 studies matched our search criteria and involved paediatric and adult patient populations. Only 15 studies evaluated pain, PONV and diet. The lack of standardised surgical and anaesthetic techniques and the variations in length of follow-up, concentration of steroids administered and patient age distribution weaken the impact of the results recorded in several studies. However, two-thirds show that a single intravenous dose of dexamethasone reduces pain, although this was limited to the early postoperative period. Moreover, 15 studies confirmed a beneficial effect of dexamethasone on both PONV and early oral intake. CONCLUSIONS Preoperative administration of a single dose of dexamethasone to reduce postoperative morbidity resulting from tonsillectomy is supported by several studies. Adverse events have never been reported. However, further studies are warranted to determine the optimum dose required and the effect in adult tonsillectomy patients. In addition, the data should be based on standardised surgical and anaesthetic techniques to allow reliable evaluation of the significance of all outcome measures.
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Affiliation(s)
- J P Windfuhr
- Klinik für Hals-, Nasen-, Ohren-Krankheiten. Kopf-, Hals- und Plastische Gesichtschirurgie, Malteser Krankenhaus St. Anna, Albertus Magnus-Strasse 33, 47259, Duisburg, Deutschland.
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Aubrun F, Marsac A, Barakat T. [Prevention and relief of pain induced by otolaryngological and cervicofacial surgery]. ANNALES D'OTO-LARYNGOLOGIE ET DE CHIRURGIE CERVICO FACIALE : BULLETIN DE LA SOCIETE D'OTO-LARYNGOLOGIE DES HOPITAUX DE PARIS 2007; 124 Suppl 1:S28-S33. [PMID: 18047861 DOI: 10.1016/s0003-438x(07)80007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pain after otolaryngological and cervicofacial surgery varies greatly because of the wide variety of procedures. Preventing this pain stems from the administration of paracetamol, nonsteroid anti-inflammatory drugs, nefopam, and systematic recourse to morphine when remifentanil is used. Postoperatively, the most painful surgical procedures are an indication for multimodal anesthesia and patient-controlled morphinic analgesic after titration in the postoperative postanesthesia care unit. Applying antalgic protocols, also including locoregional anesthesia, depending on the type of procedure and the patient, can improve the quality of care.
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Affiliation(s)
- F Aubrun
- Département d'anesthésie-réanimation chirurgicale, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'hôpital, 75013 Paris, France.
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Macassey EA, Baguley C, Dawes P, Gray A. 15-YEAR AUDIT OF POST-TONSILLECTOMY HAEMORRHAGE AT DUNEDIN HOSPITAL. ANZ J Surg 2007; 77:579-82. [PMID: 17610697 DOI: 10.1111/j.1445-2197.2007.04154.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Post-tonsillectomy haemorrhage is a significant complication because of its frequency and consequences. Increases in post-tonsillectomy haemorrhage prevalence have been reported. There is a controversy about whether increasing the use of diathermy techniques or anti-platelet aggregation effects of analgesia could have caused this increase. We carried out an audit of post-tonsillectomy haemorrhage and examined the rates of readmission for bleeding during the period 1990-2004. We also recorded the surgical technique used and the use of perioperative non-steroidal anti-inflammatory drugs and corticosteroids. During this period there has been a significant increase in post-tonsillectomy haemorrhage with an average annual increase of 15.3% (P<0.0001, 95% confidence interval 8.5-22.5%). The increase is coincidental with the change-over to predominant diathermy technique and a routine use of postoperative non-steroidal anti-inflammatory drugs and steroids.
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Affiliation(s)
- Emily A Macassey
- Department of Otorhinolaryngology, Head and Neck Surgery, Dunedin Public Hospital, and Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
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Doshi J, Damadora M, Gregory S, Anari S. Post-tonsillectomy morbidity statistics: are they underestimated? The Journal of Laryngology & Otology 2007; 122:374-7. [PMID: 17367557 DOI: 10.1017/s0022215107006676] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractBackground:Post-tonsillectomy morbidity statistics are obtained when patients present to hospital with complications. The two common morbidities are pain and haemorrhage. Hospital-recorded morbidity rates may be an underestimation, as some patients are treated by general practitioners and are therefore not included in hospital audits.Methods:Prospective, cohort, questionnaire study to assess: the post-tonsillectomy haemorrhage rate (i.e. actual rate versus hospital recorded rate); and the number of patients with post-operative pain and/or bleeding who were treated with antibiotics by their general practitioner.Results:The response rate was 76 per cent (70/92). The actual rate of secondary haemorrhage was three times that noted in the hospital records (15.7 vs 5.7 per cent, respectively). Fifteen patients (21 per cent) required extra analgesia after discharge. General practitioners prescribed antibiotics for pain alone in six patients (11 per cent).Conclusion:The actual post-tonsillectomy haemorrhage rate is much higher than that recorded in hospital statistics. General practitioners differ in their treatment of post-tonsillectomy patients presenting with pain alone; some prescribe antibiotics in addition to analgesia.
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Affiliation(s)
- J Doshi
- Department of Otolaryngology, Darlington Memorial Hospital, UK.
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Mikkelsen S, Hilsted KL, Andersen PJ, Hjortsø NC, Enggaard TP, Jørgensen DG, Hansen M, Henriksen J, Dahl JB. The effect of gabapentin on post-operative pain following tonsillectomy in adults. Acta Anaesthesiol Scand 2006; 50:809-15. [PMID: 16879463 DOI: 10.1111/j.1399-6576.2006.01057.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study was to investigate whether a combination of rofecoxib and gabapentin could improve pain relief and reduce opioid requirements, compared with rofecoxib alone, during the first 5 days after tonsillectomy. METHODS In a randomized, double-blind, placebo-controlled study, 49 patients received gabapentin 1200 mg pre-operatively, followed by gabapentin 2 x 600 mg on the day of operation and gabapentin 3 x 600 mg for the next 5 days, or placebo. Both groups were given rofecoxib 50 mg daily. In the post-operative care unit, intravenous morphine was administered in doses of 2.5 mg on request. From 4 h to 5 days post-operatively, ketobemidone was offered as escape drug. Pain at rest and during swallowing, and side-effects, were assessed using a four-point verbal rating scale. RESULTS As a result of the global withdrawal of rofecoxib, the study had to be terminated prematurely. This report comprises the results from 22 patients in the gabapentin group and 27 patients in the placebo group. Gabapentin reduced ketobemidone requirements during the first 24 h post-operatively [4.5 mg (standard deviation, 3.0 mg) in the placebo group vs. 2.0 mg (standard deviation, 2.0 mg) in the gabapentin group; P < 0.003]. Gabapentin induced more dizziness (P < 0.002), gait disturbance (P < 0.02) and vomiting (P < 0.05) during days 0-5 than placebo. No other statistically significant differences were observed. CONCLUSION Gabapentin reduced opioid requirements in the first 24 h after tonsillectomy. The benefits of the reduced opioid intake may be overshadowed by the drawbacks of side-effects.
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Affiliation(s)
- S Mikkelsen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.
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Abstract
BACKGROUND Drugs can prevent postoperative nausea and vomiting, but their relative efficacies and side effects have not been compared within one systematic review. OBJECTIVES The objective of this review was to assess the prevention of postoperative nausea and vomiting by drugs and the development of any side effects. SEARCH STRATEGY We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to May 2004), EMBASE (January 1985 to May 2004), CINAHL (1982 to May 2004), AMED (1985 to May 2004), SIGLE (to May 2004), ISI WOS (to May 2004), LILAC (to May 2004) and INGENTA bibliographies. SELECTION CRITERIA We included randomized controlled trials that compared a drug with placebo or another drug, or compared doses or timing of administration, that reported postoperative nausea or vomiting as an outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted outcome data. MAIN RESULTS We included 737 studies involving 103,237 people. Compared to placebo, eight drugs prevented postoperative nausea and vomiting: droperidol, metoclopramide, ondansetron, tropisetron, dolasetron, dexamethasone, cyclizine and granisetron. Publication bias makes evidence for differences among these drugs unreliable. The relative risks (RR) versus placebo varied between 0.60 and 0.80, depending upon the drug and outcome. Evidence for side effects was sparse: droperidol was sedative (RR 1.32) and headache was more common after ondansetron (RR 1.16). AUTHORS' CONCLUSIONS Either nausea or vomiting is reported to affect, at most, 80 out of 100 people after surgery. If all 100 of these people are given one of the listed drugs, about 28 would benefit and 72 would not. Nausea and vomiting are usually less common and, therefore, drugs are less useful. For 100 people, of whom 30 would vomit or feel sick after surgery if given placebo, 10 people would benefit from a drug and 90 would not. Between one to five patients out of every 100 people may experience a mild side effect, such as sedation or headache, when given an antiemetic drug. Collaborative research should focus on determining whether antiemetic drugs cause more severe, probably rare, side effects. Further comparison of the antiemetic effect of one drug versus another is not a research priority.
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Affiliation(s)
- J B Carlisle
- NHS, Department of Anaesthetics, Torbay Hospital, Lawes Bridge, Torquay, Devon, UK EX6 7LU.
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Kaan MN, Odabasi O, Gezer E, Daldal A. The effect of preoperative dexamethasone on early oral intake, vomiting and pain after tonsillectomy. Int J Pediatr Otorhinolaryngol 2006; 70:73-9. [PMID: 15979735 DOI: 10.1016/j.ijporl.2005.05.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Accepted: 05/08/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Postoperative morbidity in patients undergoing tonsillectomy with or without adenoidectomy includes inadequate oral intake, pain, nausea, vomiting and bleeding. The purpose of this study is to evaluate the effect of preoperative 0.5 mg/kg i.v. dexamethasone on postoperative early oral intake, pain, vomiting in patients undergoing adenotonsillectomy while performing standard anesthesia technique and sharp dissection tonsillectomy. METHODS In this prospective, double-blinded, placebo-controlled study 62 children, aged 4-12 years, who underwent tonsillectomy with or without adenoidectomy were randomly assigned to receive single dose of 0.5 mg/kg i.v. dexamethasone preoperatively. Patients started to receive 100 ml of clear fluids 2 h postoperatively, then were offered every hour. When pain score was 3 or above, paracetamol was given for pain control. Tolerating 400 ml of clear fluids, no bleeding and no vomiting were accepted as discharge criteria. The discharge time was also recorded. The incidence of early vomiting, pain scores, amount of oral intake were recorded until the discharge time. RESULTS Compared with placebo, the patients who received preoperative dexamethasone had significantly less pain score during the first 6 h postoperatively (p<0.05), adequate amount of oral intake time was shorter (p<0.05) and the discharge time was earlier (p<0.05). No difference was found in vomiting incidence in both groups. CONCLUSION Preoperative dexamethasone use significantly reduces early posttonsillectomy pain, improves oral intake and facilitates meeting the discharge criteria while using standard anesthesia technique and sharp dissection tonsillectomy without any significant side effects.
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Affiliation(s)
- M Nil Kaan
- Adnan Menderes University, School of Medicine, Department of Anesthesiology and Reanimation, 09100 Aydin, Turkey.
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Abstract
BACKGROUND Post-operative morbidity following tonsillectomy remains an important clinical problem despite advances in anesthetic and surgical techniques. This study investigated the effect of a one-day course of intravenous dexamethasone on recovery from tonsillectomy. PATIENTS AND METHODS In a double-blind, randomized, placebo-controlled trial, 30 consecutive adult patients between 18 and 35 years of age, who had no previous or known contraindications to steroid therapy, were randomly assigned at the time of surgery to either a 24-hour course of dexamethasone (3 doses of 6 mg IV) or placebo with the first dose administered during surgery, and subsequent doses given after 8 and 16 hours. The same surgeon treated all patients. Postoperative signs and symptoms, including pain, nausea, vomiting, progress of healing and the degree of granulation, were evaluated for 2 weeks. RESULTS Patients treated with dexamethasone showed significantly less pain, nausea and vomiting, better healing and less granulation. There were no side effects reported. CONCLUSION Application of 3 doses of dexamethasone within 24 hours during and after tonsillectomy is advisable because of the reduction of postoperative morbidity, especially pain and edema.
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Affiliation(s)
- Ali Maeed Al-Shehri
- Department of Surgery, College of Medicine and Medical Sciences, King Khalid University, Abha, Saudi Arabia.
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Umuroğlu T, Eti Z, Ciftçi H, Yilmaz Göğüş F. Analgesia for adenotonsillectomy in children: a comparison of morphine, ketamine and tramadol. Paediatr Anaesth 2004; 14:568-73. [PMID: 15200654 DOI: 10.1111/j.1460-9592.2004.01223.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Establishment of good analgesia is of major concern in the postoperative period following adenotonsillectomy. The aim of this study was to compare the effects of ketamine, morphine and tramadol on postoperative pain after adenotonsillectomy in children. METHODS Sixty children (age 5-12 years) scheduled for adenotonsillectomy were randomized into four groups to receive intravenously (i.v.) either 0.5 mg.kg(-1) ketamine hydrochloride (K), 0.1 mg x kg(-1) morphine hydrochloride (M), 1.5 mg x kg(-1) tramadol hydrochloride (T) or normal saline (S) in a volume of 4 ml during induction. After tracheal intubation 10 microg x kg(-1).min(-1) ketamine hydrochloride in group K and 0.6 ml x kg(-1) x h(-1) saline i.v. in groups M, K and S were infused peroperatively. Postoperative analgesic requirements and side-effects were recorded. Pain was assessed by the Numeric Rating Scale (NRS) and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores. RESULTS Heart rate increased significantly peroperatively only in group K. NRS at first and fifth minute in group M and at first minute in group T and K and CHEOPS score at first, fifth, 15th and 60th min in group M were found to be significantly lower than in the control group. The time to first analgesic requirement was significantly longer in group M compared with ketamine and the control group. Six children in group M, nine in group T, 11 in group K and 15 in group S needed additional analgesics. CONCLUSIONS Morphine hydrochloride 0.1 mg x kg(-1) i.v. administered during induction of anaesthesia provides efficient pain relief in children undergoing adenotonsillectomy.
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Affiliation(s)
- Tümay Umuroğlu
- Department of Anaesthesiology and Reanimation, Medical Faculty of Marmara University, Istanbul, Turkey.
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Abstract
BACKGROUND Tonsillectomy continues to be one of the most common surgical procedures performed worldwide. Despite advances in anesthetic and surgical techniques, post-tonsillectomy morbidity remains a significant clinical problem. OBJECTIVES To assess the clinical efficacy of a single intra-operative dose of dexamethasone in reducing post-tonsillectomy morbidity. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register (Issue 1, 2002), MEDLINE (from 1966 - February 2002), EMBASE (from 1974 - February 2002) and reference lists of relevant articles. We contacted leading experts for information on any relevant unpublished data. SELECTION CRITERIA Randomized, double-blind, placebo-controlled trials of a single dose of intravenous, intra-operative corticosteroid for pediatric patients (age < 18 years) who underwent tonsillectomy or adenotonsillectomy were included. DATA COLLECTION AND ANALYSIS Data regarding the primary outcome measures and measurement tools were extracted by the first author from the published studies. Data regarding study design, patient ages, procedures performed, dose of corticosteroid and method of delivery, as well as methodologic quality were also recorded by the first author. When data were missing from the original publications, the authors were contacted for more information. Data analysis was performed with a random effects model, using the RevMan 4.1 software developed by the Cochrane Collaboration. MAIN RESULTS Children receiving a single intra-operative dose of dexamethasone (dose range = 0.15 to 1.0 mg/kg; maximum dose range = 8 to 25 mg) were two times less likely to vomit in the first 24 hours than children receiving placebo (RR = 0.54, CI95 = 0.42, 0.69; p < 0.00001). Routine use in four children would be expected to result in one less patient experiencing post-tonsillectomy emesis (RD = -0.25, CI95 = -0.37, -0.13; p = 0.00004). Additionally, children receiving dexamethasone were more likely to advance to a soft/solid diet on post-tonsillectomy day 1 (RR = 1.69, CI95 = 1.02, 2.79; p = 0.04) than those receiving placebo. Due to missing data and varied outcome measurement tools, pain could not be meaningfully analyzed as a distinct outcome measure. REVIEWER'S CONCLUSIONS The evidence suggests that a single intravenous dose of dexamethasone is an effective, relatively safe and inexpensive treatment for reducing morbidity from pediatric tonsillectomy. No adverse events attributable to dexamethasone were reported in these trials. Additionally, in our 10-year experience of routine use of a single intravenous dose of dexamethasone during pediatric tonsillectomy, there have been no attributable, adverse events. Lastly, we found no reports in the literature of complications from use of a single intravenous dose of corticosteroid during pediatric tonsillectomy.
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Affiliation(s)
- D L Steward
- Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Sabin Way, ML 0528 - Dept of OTO-HNS, Cincinnati, OH 45267-0528, USA
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