Pain Management After Surgical Tonsillectomy: Is There a Favorable Analgesic?

Abstract

The aim of this study was to examine how ibuprofen and paracetamol prevent pain after cold-steel extracapsular tonsillectomy in children. Also, we examined the relation between age, gender, nausea, postoperative bleeding, antibiotic use, type of diet, and postoperative pain intensity and the type of administered analgesic. A prospective study was conducted on 147 children (95 males and 52 females, aged 7-17 years) who underwent tonsillectomy in the Clinical-Hospital Center “Dragiša Mišović” from January 1 to June 30, 2016. The degree of pain was measured using a visual analog scale (VAS). We did not observe any significant differences in postoperative nausea, hospitalization rate postoperative bleeding, and antibiotic use between the paracetamol and ibuprofen groups. A test of within-patient effects showed that VAS scores changed significantly during the postoperative follow-up period ( P = .00), but there were no significant differences between the groups ( P = .778). After 12 hours, 29.3% of the patients on paracetamol and 21.8% on ibuprofen were transferred to a soft diet; after 24 hours, 84.8% of the paracetamol group and 85.5% of the ibuprofen group were on a soft diet (χ2 test, P < .05). There was a statistically significant correlation between VAS scores measured 4 hours after the surgery and the time of transference to the soft diet (Spearman ρ test, P < .001). The transfer to soft and normal diets was not significantly different between the 2 groups as assessed by the VAS scores (Pearson χ2 test, P = .565).There is still no consensus on the most effective postoperative pain-control regiment after tonsillectomy. This study showed that satisfactory pain management was achieved equally with both paracetamol and ibuprofen.

Efficacy of topical 0.5% bupivacaine in pain reduction in pediatric tonsillectomy patients

“…15.18±1.60in group A and 14.96±1.34 in group B. None of the other studies have described BMI, which is a feature unique to our study.…”

“…Various options for pain reduction have been tried after tonsillectomy, like the use of topical lignocaine [6] , ropivacaine [7] , daflon [8] , dexamethasone [9] , bupivacaine [10] , pregabalin [11] etc. in addition to systemic use of NSAIDs, narcotic analgesics and steroids [12,13] . Different sealants have been used to cover the surgical wound in order to prevent sensory nerves from being exposed to reduce pain.…”

“…Freeman et al [14] achieved good using sucralfate in adult patients [14] . Stoeckli et al used fibrin glue to cover the surgical wound but reported no benefit with this technique [15] . Few studies have been undertaken reflecting mixed results, one of the earlier studies, Violaris and Tuffin, applied topical bupivacaine to the surgical wounds of adult patients and compared it with the application of normal saline and reported the side treated with normal saline showed less pain than the side coated with 0.5% bupivacaine [16] .…”

Analgesic Effects and Safety of Dexmedetomidine Added to Nalbuphine or Sufentanil Patient-Controlled Intravenous Analgesia for Children After Tonsillectomy Adenoidectomy

“…For example, codeine is no longer approved for children aged less than 12 years undergoing tonsillectomy due to obstructive sleep apnea syndrome resulting from clinically relevant polymorphisms in CYP2D6 activity in Europe and United States ( Tobias et al, 2016 ). Paracetamol in combination with a non-steroidal anti-inflammatory drug attenuated the pain after tonsillectomy in children more efficiently ( Jotić et al, 2019 ), while further studies of morphine addition showed mixed results ( Kelly et al, 2015 ; Oremule et al, 2015 ). Additionally, administration of opioids has been associated with adverse reactions, such as the risk of respiratory depression in case of overdosing and postoperative nausea and vomiting ( Kiyatkin, 2019 ).…”

A Comparative study of intraoperative peritonsillar infiltration versus intravenous dexemedetomidine for perioperative analgesia in tonsillectomy

“…1 In the light of problems associated with postoperative pain, various strategies in the management of postoperative pain in these patients have been proposed like infiltration of local anaesthetic, non-steroidal anti-inflammatory drugs (NSAID), narcotic and oral analgesics. 2,3 The usual trend is to prescribe an opioid or NSAID for perioperative analgesia. Opioids may cause nausea, respiratory depression, hypotension, dizziness, mental confusion, constipation, itching and urinary retention.…”