Oxycodone and Dexamethasone for pain management after tonsillectomy: A placebo-controlled EMG assessed clinical trial

Abstract

SummaryBackgroundSurface electromyographic (sEMG) study of post-tonsillectomy swallow-evoked muscular reactions was performed in order to evaluate the efficacy and safety of oxycodone and dexamethasone in pain management after tonsillectomy.Material/Methods90 randomly chosen operated adults were divided into three groups. Group 1 (n=30) was treated with OxyContin (Oxycodone) injections; Group 2 (n=30) was treated with Dexacort (Dexamethasone), and Group 3 (n=30) was a placebo group. Pain assessment included visual analogue scale (VAS) pain score and the EMG data like the timing, electric amplitude and graphic patterns of muscular activity during deglutition. We investigated masseter, infrahyoid and submental-submandibular muscles. Records from trapezius muscle were used for control. The results were compared with previously established normative database. The patients were tested 24 h after surgery. The sEMG data were compared with VAS pain score with regard to changes in clinical condition of the patients.ResultsAnalgesia with oxycodone smoothed the recorded sEMG swallow peaks and increases time of deglutition. Dexamethasone normalized muscular activity in deglutition in cases with edema as detected by the EMG records. Statistically significant difference in muscle reactions was detected between the two Groups and the placebo group.ConclusionsApplication of oxycodone significantly reduces the postoperative pain. Application of dexamethasone after tonsillectomy is advisable because of the reduction of postoperative morbidity while the reduction of the postoperative pain is secondary to the reduction of edema. SEMG might be used as an adjunctive measure of pain behavior via assessment of muscular reactions to pain and to analgesia.

Acetaminophen, ibuprofen, and tramadol analgesic interactions after adenotonsillectomy

“…Despite the use of paracetamol and nonsteroidal anti‐inflammatory drug combination therapy children continue to suffer pain after adenotonsillectomy . Medications such as tramadol, codeine, morphine, oxycodone, and hydrocodone have all been used to supplement analgesia. Tramadol 1 mg/kg may have less potential to cause respiratory depression than equivalent doses of other opioid analgesics, but the drug's impact as a supplemental analgesic after adenotonsillectomy is poorly quantified.…”

Update review of pain control methods of tonsil surgery

“…Persino et al [32] have suggested that acetaminophenhydrocodone prescription is therapeutically valuable in posttonsillectomy patients. Application of oxycodone reduces post-tonsillectomy pain [33] . However, this medication could depress ventilation and precipitate apnea to a larger extent in children with obstructive sleep apnea syndrome [34] .…”

Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults

“…Surgery was performed under general anaesthesia in 27 studies; in two studies the type of anaesthesia was not reported. 25,41 The surgical method was described in 19 studies.…”

“…Rescue analgesics were given in 25 studies, were not allowed in one study, 37 and information was not provided in three studies. 34,43,51 Study medications were administered before operation in eight studies, 29e31,45e49 before operation and intraoperatively in one study, 44 intraoperatively in seven studies, 8,26,34,35,38,43,50 intraoperatively and after operation in five studies, 27,32,36,37,39 after operation in seven studies, 23e25, 33,40,41,51 and before and after operation in one study. 44 One study compared intraoperative and postoperative administration of the study medication with placebo.…”