Objective Evaluate intraoperative cooling of the oropharynx to reduce postoperative pain in tonsillectomy using monopolar electrocautery. Methods Sixty-six patients, age 1 to 12 years, were selected for the study, 33 in the control group and 33 in the experimental group. After randomization, patients underwent subcapsular dissection and hemostasis with monopolar electrocautery. Patients in the experimental group had the oropharynx cooled after tonsil dissection and hemostasis for 10 minutes. The procedure was done through the oral cavity by irrigation with 500 mL of 0.9% saline, in temperatures between 5°C and 10°C, for 5 minutes. The evaluation of postoperative pain was made with the pain visual analog scale (VAS) for 10 days. As complementary data on the evaluation of pain, we recorded daily use of ketoprofen for pain relief. Results Pain after tonsillectomy assessed by VAS was significantly lower in the experimental group at days 0, 5, and 6 (p < 0.05). There were no differences in the use of ketoprofen between the groups. Conclusion Cooling of the oropharynx after tonsillectomy promotes clinically significant reduction in postoperative pain, without additional complications.
Introdução: A hérnia diafragmática é definida pela passagem de parte do conteúdo abdominal para o interior da cavidade torácica através de um defeito no diafragma. Pode ser congênita, gerando hipoplasia e hipertensão pulmonar, ou adquirida, principalmente após trauma. Em adultos, normalmente é diagnosticada incidentalmente ou cursa com sintomas inespecíficos. Objetivo: Descrever um caso de hérnia diafragmática congênita crônica diagnosticada tardiamente em paciente adulto. Descrição do caso: E.B.M, sexo masculino, 50 anos, com quadro inespecífico de dor torácica e abdominal. Após solicitação de exames de imagem, foi diagnosticado com hernia diafragmática volumosa e indicada abordagem cirúrgica. Foi submetido à toracotomia para correção de hérnia diafragmática sem intercorrências, com identificação no intraoperatório de cólon, parte do intestino delgado, fígado e vesícula biliar na cavidade torácica. Após alta hospitalar, retornou para seguimento ambulatorial, assintomático. Considerações finais: A hérnia diafragmática crônica apresenta diagnóstico difícil na idade adulta, visto que tendem a permanecer assintomáticas. Quando sintomáticas, geram sintomas inespecíficos ou culminam em complicações, como obstrução intestinal ou estrangulamento de vísceras ocas herniadas.
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