Management of pain after tonsillectomy: a prospective, randomized clinical study

Year 2009, Volume: 19 Issue: 1, 1 - 8, 01.02.2009

Nusret İnci Oğuz Basut Fikret Kasapoğlu Hamdi Hakan Coşkun

Abstract

Objectives: We evaluated the alleviation of posttonsillectomy pain with systemic and topical applications. Patients and Methods: Data obtained from 78 patients 28 females, 50 males who had undergone tonsillectomy for recurrent tonsillitis by conventional cold surgery were reviewed with prospective, randomized clinical study. Initially, the patients were assigned into topical and systemic drug groups. These groups were then divided into three sub-groups; i clindamycin, dexamethasone, and control saline ii groups for the topical drug group; iii cefprozil, amoxicillin+clavulanate and control no medications except analgesic for the systemic drug group. The intensity of pain perceived by the patients at 21 different times was assessed by visual analog scale and facial scale. Results: No significant relation was found between topical or systemic antibiotic use and pain intensity after tonsillectomy. Conclusion: Neither topical application nor systemic administration is significantly superior to the other for postoperative management of pain.

Keywords

Analgesics, clinical trial, pain, postoperative, tonsillectomy

Tonsillektomi sonrası ağrının tedavisi: Prospektif, randomize klinik çalışma

Abstract

Amaç: Tonsillektomi sonrası oluşan ağrının, sistemik ve topikal uygulamalarla ortadan kaldırılması değerlendirildi.Hastalar ve Yöntemler: Tekrarlayan tonsillit nedeniyle, geleneksel soğuk cerrahi yöntem kullanılarak tonsillektomi uygulanan 78 hastanın 28 kadın, 50 erkek bilgileri, prospektif, randomize klinik çalışma için değerlendirildi. Hastalar ilk olarak topikal ve sistemik ilaç gruplarına ayrıldı. Sonrasında bu gruplar, kendi içinde üç alt gruba ayrıldı; i topikal ilaç grubu klindamisin, deksametazon ve kontrol salin , ii sistemik ilaç grubu sefprozil, amoksisilin-klavulanat ve iii kontrol analjezik dışında ilaç verilmedi gruplarına ayrıldı. Hastalar tarafından algılanan ağrının şiddeti 21 farklı zamanda görsel analog skala ve fasiyal skala ile değerlendirildi. Bulgular: Sistemik ve topikal antibiyotik kullanımıyla tonsillektomi sonrası oluşan ağrının şiddetinde belirgin hiçbir etkileşimin olmadığı gözlendi. Sonuç: Ne topikal uygulama ne de sistemik ilaç kullanımı ameliyat sonrası ağrı tedavisinde birbirine üstün değildir

Keywords

Analjezik, klinik çalışma, ağrı, ameliyat sonrası, tonsillektomi

References

• Freeman SB, Markwell JK. Sucralfate in alleviating post- tonsillectomy pain. Laryngoscope 1992;102:1242-6.
• Jebeles JA, Reilly JS, Gutierrez JF, Bradley EL Jr, Kissin I. Tonsillectomy and adenoidectomy pain reduction by local bupivacaine infiltration in children. Int J Pediatr Otorhinolaryngol 1993;25:149-54.
• Kaygusuz I, Susaman N. The effects of dexametha- sone, bupivacaine and topical lidocaine spray on pain after tonsillectomy. Int J Pediatr Otorhinolaryngol 2003;67:737-42.
• Erişen L, Basut O, Coşkun H, Tezel İ, Hızalan İ, Onart S. Adenotonsillektomi olgularımız ve endikasyonların değerlendirilmesi. Kulak Burun Boğaz Klinikleri 1999;1:85-8.
• Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage 1994;9:56-9.
• Murthy P, Laing MR. Dissection tonsillectomy: pattern of post-operative pain, medication and resumption of normal activity. J Laryngol Otol 1998;112:41-4.
• Ozcan M, Altuntaş A, Unal A, Nalça Y, Aslan A. Sucralfate for posttonsillectomy analgesia. Otolaryngol Head Neck Surg 1998;119:700-4.
• Yalçın Ş, Çelik O, Bolat E. Tonsillektomi sonrası topikal ve sistemik antibiyotik profilaksisi. Fırat Üniversitesi Sağlık Bilimleri Dergisi 1994;8:87-90.
• Broadman LM, Patel RI, Feldman BA, Sellman GL, Milmoe G, Camilon F. The effects of peritonsillar infil- tration on the reduction of intraoperative blood loss and post-tonsillectomy pain in children. Laryngoscope 1989;99:578-81.
• Jamison RN. Clinical measurement of pain. In: Ferrante FM, VadeBoncouer TR, editors. Postoperative pain management. New York: Churchill Livingstone; 1993. p. 119 -32.
• Tulunay M, Tulunay FC. Ağrı değerlendirilmesi ve ağrı ölçümleri. In: Erdine S, editör. Ağrı. İstanbul: Nobel Tıp Kitapevi; 2000. s. 91-110.
• Mann EA, Blair EA, Levy AJ, Chang A. Effect of topical antibiotic therapy on recovery after tonsillectomy in adults. Otolaryngol Head Neck Surg 1999;121:277-82.
• Grandis JR, Johnson JT, Vickers RM, Yu VL, Wagener MM, Wagner RL, et al. The efficacy of perioperative antibiotic therapy on recovery following tonsillectomy in adults: randomized double-blind placebo-controlled trial. Otolaryngol Head Neck Surg 1992;106:137-42.
• Brook I, Foote PA. Effect of penicillin or cefprozil therapy on tonsillar flora. J Antimicrob Chemother 1997;40:725-8.
• Kutcher MJ, Ludlow JB, Samuelson AD, Campbell T, Pusek SN. Evaluation of a bioadhesive device for the management of aphthous ulcers. J Am Dent Assoc 2001;132:368-76.
• Curtin JM. The history of tonsil and adenoid surgery. Otolaryngol Clin North Am 1987;20:415-9.
• Lee WC, Duignan MC, Walsh RM, McRae-Moore JR. An audit of prophylactic antibiotic treatment fol- lowing tonsillectomy in children. J Laryngol Otol 1996;110:357-9.
• Catlin FI, Grimes WJ. The effect of steroid therapy on recovery from tonsillectomy in children. Arch Otolaryngol Head Neck Surg 1991;117:649-52.
• Telian SA, Handler SD, Fleisher GR, Baranak CC, Wetmore RF, Potsic WP. The effect of antibiotic ther- apy on recovery after tonsillectomy in children. A controlled study. Arch Otolaryngol Head Neck Surg 1986;112:610-5.
• Oghan F, Harputluoglu U, Guclu E, Kocaman B, Ozturk O. Does topical ropivacaine reduce the post- tonsillectomy morbidity in pediatric patients? Int J Pediatr Otorhinolaryngol 2008;72:361-5.
• Lachance M, Lacroix Y, Audet N, Savard P, Thuot F. The use of dexamethasone to reduce pain after tonsil- lectomy in adults: a double-blind prospective random- ized trial. Laryngoscope 2008;118:232-6.
• Linden BE, Gross CW, Long TE, Lazar RH. Morbidity in pediatric tonsillectomy. Laryngoscope 1990;100:120-4.
• Stringel G, Bawdon R, Savrich M, Guertin L, Horton J. Topical and systemic antibiotics in the prevention of wound infection. J Pediatr Surg 1989;24:1003-6.
• Becker GD. Chemoprophylaxis for surgery of the head and neck. Ann Otol Rhinol Laryngol Suppl 1981;90:8-12.
• Camnitz PS, Biggers WP, Fischer ND. Avoidance of early complications following radical neck dissection. Laryngoscope 1979;89:1553-62.
• Johnson JT, Myers EN, Thearle PB, Sigler BA, Schramm VL Jr. Antimicrobial prophylaxis for contaminated head and neck surgery. Laryngoscope 1984;94:46-51.
• Liu CM, Su CY. Post-operative pain control with topi- cal steroid injection after hot dissection tonsillectomy. J Laryngol Otol 1996;110:1038-40.
• Carr MM, Williams JG, Carmichael L, Nasser JG. Effect of steroids on posttonsillectomy pain in adults. Arch Otolaryngol Head Neck Surg 1999;125:1361-4.
• Colreavy MP, Nanan D, Benamer M, Donnelly M, Blaney AW, O’Dwyer TP, et al. Antibiotic prophy- laxis post-tonsillectomy: is it of benefit? Int J Pediatr Otorhinolaryngol 1999;50:15-22.
• Warnock FF, Lander J. Pain progression, intensity and outcomes following tonsillectomy. Pain 1998;75:37-45.