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PubMed2005

A randomized, placebo-controlled study of rofecoxib with paracetamol in early post-tonsillectomy pain in adults.

BACKGROUND AND OBJECTIVE: Effective and early treatment of postoperative pain and nausea have become pivotal for the early discharge of patients after tonsillectomy. Opioid-based analgesia is standard practice but the use of non-steroidal anti-inflammatory drugs is discouraged due to their platelet inhibiting properties. The cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drugs are effective analgesics and do not affect platelet function. We hypothesized that premedication with cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drug in addition to paracetamol would provide effective analgesia and decrease opioid consumption during early recovery from tonsillectomy. METHODS: In a randomized, placebo-controlled study of adult tonsillectomy patients (n=40) one group (R-group; n=20) was premedicated with paracetamol 1.5 g and rofecoxib 50 mg and a control group (P-group; n=20) was premedicated with paracetamol 1.5 g and placebo. Morphine was used as rescue medication. Postoperative (24 h) pain scores (0--10), morphine consumption as well as intraoperative blood loss were recorded. RESULTS: We found no overall difference in pain scores between the groups but significantly more patients in the placebo group had pain scores >5 within the first 8 h. The rofecoxib group consumed less morphine during the first 12 h. A lower intraoperative blood loss was observed in the rofecoxib group. CONCLUSION: Our results suggest an early although clinically minor analgesic benefit of the addition of a cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drug to paracetamol as premedication for adult tonsillectomy.

Acetaminophen↗

PubMed2002

Temporomandibular joint dysfunction following tonsillectomy.

We report a prospective, controlled trial to assess temporomandibular joint (TMJ) dysfunction following the use of a Boyle-Davis mouth gag during tonsillectomy. TMJ function was evaluated in patients undergoing tonsillectomy and a control group undergoing nasal surgery preoperatively and 6 weeks postoperatively. The main outcome measures were symptoms and signs of TMJ dysfunction and interincisal distance. A mean reduction of 0.89 mm in interincisal distance (P < 0.01) was noted postoperatively in the tonsillectomy patients. There was no statistically significant reduction of interincisal distance in patients undergoing nasal surgery. There was a statistically significant reduction in interincisal distance in the post-tonsillectomy patients, caused by fibrous healing of the tonsillar bed or fibrous ankylosis of the TMJ.

Adolescent↗

PubMed2000

Comparative audit of tonsillectomy.

The Comparative Audit Service of the Royal College of Surgeons of England undertook an audit of tonsillectomy throughout England and Wales in 1997. There were three parts to the audit: a management questionnaire related to tonsillectomy and its indications; an inpatient questionnaire for patients undergoing tonsillectomy; and a postoperative patient questionnaire. One hundred and fourteen ENT consultants returned the management questionnaire, 2450 questionnaires on inpatient details were returned by 132 consultants, and 1408 patients returned postoperative questionnaires. Two-thirds of the patients underwent tonsillectomy for recurrent acute tonsillitis, and most stayed 1 night in hospital; only 3% were day cases. Postoperative haemorrhage necessitated return to theatre for 0.75% of patients. Almost 7% of patients had to be readmitted after discharge. Overall, 92% of patients felt that their throat was better than before the operation, but slightly less than this number (88%) were pleased that they had the operation. The results are further discussed in the paper. The ability to cross-reference each part of the audit for individual patients proved extremely useful.

Adolescent↗

PubMed2000

A randomised controlled trial of the effect of regional nerve blocks on immediate post-tonsillectomy pain in adult patients.

Post-operative pain is the main cause of morbidity following tonsillectomy. The efficacy of glossopharyngeal and lesser palatine nerve blocks in controlling postoperative pain in adult patients was investigated prospectively. Patients 16 years and older admitted for elective tonsillectomy were randomised to one of three groups to receive a pre-incisional oropharyngeal injection of 0.5% bupivicaine, a 'dummy' injection of saline or no injection. Dissection tonsillectomy and general anaesthetic techniques were standardized. Postoperative pain was monitored for 24 h. ANOVA, chi2 and Fisher's exact test were used for intergroup comparisons. Ninety-two patients (72 women and 20 men), mean age 22 years were studied. Twenty-nine patients received 0.5% bupivicaine, 30 saline and 33 no pre-incisional injection. The overall mean pain scores of 2.1, 1.9 and 1.9 in the bupivicaine, saline and no injection groups were similar. Glossopharyngeal and lesser palatine 0.5% bupivicaine nerve blocks are not effective in reducing early post-tonsillectomy pain.

Adult↗

PubMed2001

A comparison of sleep quality in normal children and children awaiting (adeno)tonsillectomy for recurrent tonsillitis.

Poor quality sleep and sleep-related hypoxia have been described in children awaiting (adeno)tonsillectomy even in the absence of a history which would suggest such problems. However, restless sleep has also been commonly reported in children from a normal population. It has not been shown whether an increasing frequency of tonsillitis is associated with deterioration in sleep quality. This study directly compares sleep quality in three groups of children: (1) a normal population; (2) children from a normal population who have tonsillitis but are not awaiting tonsillectomy; and (3) children awaiting tonsillectomy for recurrent tonsillitis. A questionnaire was completed by the parents and the answers compared using the chi2 and Spearman's rank correlation tests. The results show that children awaiting tonsillectomy have poorer sleep quality than their normal peers. However, there is no dose-response effect between deteriorating sleep quality and increasing frequency of tonsillitis.

Adenoidectomy↗

PubMedDate not supplied

[Preoperative coagulation screening prior to adenoidectomy and tonsillectomy].

BACKGROUND: Laboratory tests are widely used to screen children with planned surgery to detect unknown coagulation defects. This study investigates the predictive value of commonly used coagulation tests (thromboplastin time, partial thromboplastin time and thrombocyte count) compared with a standardized bleeding history. PATIENTS: In 702 patients 500 adenoidectomies and 500 tonsillectomies were done, results of laboratory evaluation and individual bleeding history were evaluated. RESULTS: 9.4 % of all laboratory tests showed abnormal results. 30.5 % of the children awaiting adenoidectomy had a suspicious bleeding history as had 22 % of patients undergoing tonsillectomy. In the clinical course of adenoidectomy no bleeding occurred. After tonsillectomy 15 children (3 %) showed moderate, 12 patients (2.4 %) severe postoperative bleeding. The positive predictive value of coagulation screening reached 6.8 % whereas history alone predicted 9.2 % of observed post tonsillectomy bleeding. CONCLUSIONS: The results of this study demonstrate the lacking effect of laboratory tests to predict postoperative bleeding complications. Taking a careful history of bleeding risks and testing only patients with suspicious history reduces the risk of bleeding more effective. Counseling about bleeding symptoms and postoperative survey of patients are additional measures which may protect the children.

Adenoidectomy↗

PubMed1996

[Surgically managed postoperative hemorrhage after tonsillectomy].

BACKGROUND: Bleeding after tonsillectomy is the most frequent and most dangerous complication. We compared the incidence of postoperative bleeding and secondary haemorrhage after tonsillectomy was examined using two methods of hemostasis (suture ligation versus electrocautery). METHODS: The study covered all tonsillectomies performed from 1992 to 1994. Data from about 2096 patients were assessed. RESULTS: The incidence of postoperative bleeding and hemorrhage was 5.4%. When suture ligation of vessels was used to obtain hemostasis during the operation it was evident that postoperative bleeding was rare but more difficult in comparison to the cases in which electrocautery was used alone. While primary bleeding for both methods was similar, secondary bleeding was more frequent after hemostasis achieved with electrocautery. DISCUSSION: Injury of the vessel by suture ligation is thought to be responsible for massive hemorrhage after tonsillectomy. Using electrocautery avoids this pathogenic mechanism. Since electrocautery of the tissue surrounding a vessel produces initial hemostasis, secondary bleeding is more frequent after the wound clot is opened. CONCLUSION: Use of electrocautery for hemostasis is justified since bleeding after primary hemostasis is usually easily managed.

Adolescent↗

PubMed2002

A comparison of tonsillectomy with the harmonic scalpel versus electrocautery.

OBJECTIVE: We sought to test whether the use of the harmonic scalpel would cause less pain and more rapid recovery in tonsillectomy patients versus the use of electrocautery. DESIGN AND SETTING: In a private practice community hospital, we conducted a prospective nonrandomized comparison of 156 pediatric tonsillectomy cases. Local anesthetic infiltrations and steroids were used at the discretion of the surgeon. Outcome variables consisted primarily of immediate- and mid-term pain, pain medications required, time to eating, morbidities and charges. RESULTS: There were no differences between the groups on an intention-to-treat basis except for costs, which were higher in the harmonic scalpel group. When rescue use of electrocautery was required to control bleeding in the in the harmonic scalpel patients, more pain and longer times to taking food were noted. CONCLUSIONS: Used with discretion the harmonic scalpel is equivalent to electrocautery for tonsillectomy. SIGNIFICANCE: The harmonic scalpel does not provide a major benefit over more conventional methods of tonsillectomy.

Adolescent↗

PubMed2003

Harmonic scalpel tonsillectomy in children: a randomized prospective study.

OBJECTIVE: In this randomized prospective study, we evaluated postoperative morbidity after use of the Harmonic Scalpel (HS), an ultrasonic dissector coagulator (Ethicon Endo-Surgery Inc, Cincinnati, OH), or conventional electrocautery (EC) during tonsillectomy. STUDY DESIGN AND SETTINGS: Pediatric subjects at 2 sites were randomized and underwent tonsillectomy. Intraoperative blood loss and operation duration were recorded. Postoperative parameters and complications were recorded. RESULTS: One hundred seventeen subjects completed the study. For the HS group, mean operative time was significantly longer (P < 0.001), but intraoperative blood loss was equivalent (P = 1.000). HS subjects slept soundly on postoperative days 1, 2, 3, and 14 (P = 0.041, 0.013, 0.022, and 0.038, respectively, compared with EC group). Mean postoperative pain scores trended lower for HS subjects on postoperative days 2, 3, and 4. CONCLUSION: The use of the HS in pediatric tonsillectomy showed no increase in intraoperative or postoperative blood loss compared with the use of EC, and HS provided possible clinical advantages over EC in patient comfort. SIGNIFICANCE: Tonsillectomy subjects in the HS group showed a statistically significant ability to sleep soundly, suggesting that the subjects experienced less pain. These data correlate with the observed decrease in pain scores.

Blood Loss, Surgical↗

PubMed2002

Taste disturbance after tonsillectomy.

Of the 3583 outpatients treated at our taste disorder clinic over a period of 15 years, 11 (0.31%) complained of taste disorder after tonsillectomy. The cause of taste disorder was identified in 8 of the 11 cases: in 3 cases it was caused by direct or indirect damage to the lingual branch of the glossopharyngeal nerve; in 2 cases it was attributable to medication taken by the patient after tonsillectomy; and in 3 cases taste disturbance was caused by a lack of dietary zinc, even though this was identified at the time of tonsillectomy. These findings indicate the importance of (i) informing patients when consent for tonsillectomy is obtained that there is a risk of postoperative taste disorder; (ii) measuring the patient's taste threshold and serum zinc level preoperatively; and (iii) obtaining a thorough drug history, including details of non-prescription medications habitually taken by the patient.

Adult↗

PubMed2004

Patient contact with healthcare professionals after elective tonsillectomy.

OBJECTIVE: To assess the amount and causes of patient contact with healthcare professionals after elective tonsillectomy. MATERIAL AND METHODS: This was a prospective study. All consecutive patients undergoing elective tonsillectomy or adenotonsillectomy in 1997 received a questionnaire concerning the post-discharge period. RESULTS: A total of 276 patients (93.6%) answered questions regarding post-discharge contact. After their discharge, 43.8% of patients contacted healthcare professionals. Pain was the leading indication for telephone contact, and hemorrhage for visits in person. Information given over the telephone was sufficient in 49.5% of cases. Telephone contact was followed by a visit in person in the case of hemorrhage in 88.9% of patients and in the case of pain in 34.1%. Contact was made most frequently in the older age groups. CONCLUSIONS: Although the patients repeatedly received both written and oral information, nearly half of them still contacted healthcare professionals during the recovery period. Frequent post-tonsillectomy contact should be taken into account when the financial and personnel resources of day surgery units are evaluated. In order to reduce the amount of post-tonsillectomy contact with healthcare professionals, careful attention must be paid to the quality of patient counseling prior to discharge.

Adolescent↗

PubMed1992

A new instrument for use with Nd:YAG in tonsillectomy.

In tonsillectomy, unexpected bleeding can be one of the most troublesome surgical procedures to perform. To resolve some inherent problems, we have developed a new elevator with contact Nd:YAG laser probe for blunt dissection around the tonsillar capsule. Of 63 cases of laser tonsillectomies performed over 5 years, 51 cases were performed using conventional contact Nd:YAG laser probe and a chisel type dissector. Tonsillectomy in the remaining 12 cases was undertaken by the newly developed elevator with contact Nd:YAG laser probe. We compared clinical evaluation between laser and conventional procedures. Additionally, the advantage of laser tonsillectomy is discussed.

Adult↗

PubMed1978

Tonsillectomy and circumcision: comparisons of two cohorts.

Changes in the prevalence of tonsillectomy and circumcision in eleven year olds are described in two birth cohorts spaced 12 years apart. Both types of operation were less prevalent in the later (1958) cohort; tonsillectomy fell by a fifth and circumcision by more than half. These falls were confined to tonsillectomy before the age of six and circumcision under one year. Social class differences in tonsillectomy were found in both cohort studies but the strong social class gradient in circumcision reported in the 1946 cohort had vanished in the 1958. Regional and birth rank differences are found for both types of operation; these show substantial changes over time. These results are discussed in the context of changing professional opinions about the worth of these operations.

Child↗

PubMed1987

Tonsillectomy and Hodgkin's disease: results from companion population-based studies.

The question of whether persons with a history of tonsillectomy are at increased risk of Hodgkin's disease (HD) in adulthood was evaluated in companion population-based case-control studies conducted in the eastern Massachusetts and the Detroit metropolitan areas. These studies compared the history of tonsillectomy among incident cases with that of all their siblings by matched analysis controlling for confounding by childhood social class, family size, and birth order. Among young adults (15-39 yr) there is substantial evidence that tonsillectomy is not a risk factor and the relative risk (RR) is 1.0 (95% confidence interval, 0.72-1.4). Among middle-aged persons (40-54 yr) the RR is not significantly elevated, 1.5 (0.67-3.3), and the direction of the association differs between the sexes, consistent with the hypothesis of no association. Among older persons, the RR is significantly elevated, 3.0 (1.3-6.9), but the data are sparse. On the basis of these data, it appears unlikely that prior tonsillectomy is a causal factor in the development of HD in young and middle-aged adulthood. Whether it is a risk factor for the malignancy occurring late in life is unclear.

Adolescent↗

PubMed1995

A double-blind evaluation of ketorolac tromethamine versus acetaminophen in pediatric tonsillectomy: analgesia and bleeding.

The study was designed to compare intravenous ketorolac to rectal acetaminophen for analgesia and bleeding in pediatric patients undergoing tonsillectomy. We studied 50 patients, aged 2-15 yr undergoing tonsillectomy with or without adenoidectomy. In a randomized, prospective double-blind fashion, patients were assigned to receive either ketorolac (1 mg/kg) or rectal acetaminophen (35 mg/kg). Bleeding was evaluated by measuring intraoperative blood loss and noting extra measures required to obtain hemostasis. Bleeding times were also measured before and during surgery. Pain was evaluated using a standard objective pain score for the first 3 h. Persistent pain was treated with morphine, acetaminophen, and codeine and recorded for 24 h. Blood for determination of acetaminophen levels was drawn at 20 and 40 min after the administration of study drugs. Pain scores were not significantly different between the ketorolac and acetaminophen groups. The majority of patients in both groups required additional opioid in the postoperative period. Acetaminophen levels were all less than the therapeutic range. Intraoperative bleeding times were normal in all patients, but blood loss was significantly higher in the ketorolac group (2.67 mL/kg) compared to the acetaminophen group (1.44 mL/kg), P = 0.025. Significantly more measures to achieve hemostasis were required in the ketorolac group (P = 0.012). We conclude that ketorolac is no more effective than high-dose rectal acetaminophen for analgesia in the patient undergoing tonsillectomy. Hemostasis during tonsillectomy was significantly more difficult to achieve in patients receiving ketorolac.

Acetaminophen↗

PubMed1996

Preoperative oral ondansetron for pediatric tonsillectomy.

This prospective, randomized, double-blind, placebo-controlled study evaluated the antiemetic efficacy of preoperative oral ondansetron, 0.075 mg/kg or 0.15 mg/kg, in 136 preadolescent children premedicated with midazolam 0.5 mg/kg per os and dexamethasone 0.1 mg/kg intravenously prior to undergoing tonsillectomy with isoflurane anesthesia. The incidence of vomiting during the 24 h after tonsillectomy was significantly reduced (P < 0.04) by ondansetron 0.15 mg/kg compared with placebo and ondansetron 0.075 mg/kg (15%, 38%, and 36%, respectively). There was a significant reduction (P < 0.03) in the mean number of vomiting episodes per patient during the 24 h immediately after tonsillectomy in the ondansetron 0.15 mg/kg group compared with the placebo and ondansetron 0.075 mg/kg study groups (0.2 +/- 0.6, 0.8 +/- 1.3, and 0.8 +/- 1.3, respectively). The need for antiemetic rescue therapy (ondansetron 0.15 mg/kg intravenously after three episodes of emesis prior to discharge) was significantly greater in children who received placebo compared with the ondansetron 0.15 mg/kg study group (13% vs 0%, P < 0.05). We conclude that ondansetron 0.15 mg/kg, administered orally prior to tonsillectomy, is associated with reduced postoperative vomiting in preadolescent children. In addition, the preoperative oral administration of ondansetron 0.075 mg/kg is no more effective than placebo in preventing posttonsillectomy vomiting in preadolescent children.

Administration, Oral↗

PubMed1997

Prophylaxis for vomiting by children after tonsillectomy: dexamethasone versus perphenazine.

UNLABELLED: The effects of dexamethasone and perphenazine on vomiting after tonsillectomy in children were compared in 226 healthy children aged 2-12 yr. The study was randomized, stratified, blocked, and double-blind. Anesthesia was induced intravenously (I.V.) with propofol or by inhalation with halothane and N2O. Dexamethasone 150 microg/kg or perphenazine 70 microg/kg was administered I.V. after the induction of anesthesia in a double-blind fashion. Perioperative management of emesis, pain, fluids, and patient discharge was all standardized. The groups had similar demographic characteristics. Perphenazine significantly reduced the incidence of in-hospital vomiting compared with dexamethasone (13% vs 36%, P < 0.001). The incidence of out-of-hospital vomiting was almost identical. Overall, the incidence was significantly different for perphenazine vs dexamethasone (33% vs 46%, P = 0.04) using logistic regression analysis. Of note, sex and induction technique were significant predictors of postoperative vomiting (P < 0.05) using logistic regression analysis, with male patients and those patients undergoing I.V. induction vomiting less. In conclusion, perphenazine more effectively decreases vomiting by children after tonsillectomy in an ambulatory hospital setting compared with dexamethasone. IMPLICATIONS: Postoperative vomiting can have many debilitating effects, and children undergoing tonsillectomy are at particular risk. We compared the effects of dexamethasone and perphenazine on vomiting after tonsillectomy in 266 children. We found perphenazine more effective than dexamethasone before discharge from hospital but that the two drugs have similar effects after discharge.

Anesthesia↗

PubMed1998

Premedication with oral dextromethorphan reduces postoperative pain after tonsillectomy.

UNLABELLED: The aim of the present study was to examine whether premedication with dextromethorphan, a clinically available N-methyl-D-aspartic acid (NMDA) receptor antagonist, could reduce postoperative pain after tonsillectomy. Thirty-six patients scheduled for elective bilateral tonsillectomy were investigated in a double-blinded, randomized study. The patients were randomly assigned to one of three groups: control, dextromethorphan 30 mg (Dex 30), and dextromethorphan 45 mg (Dex 45) groups. In the control group, premedication was with oral placebo and intramuscular (i.m.) midazolam and atropine. In the Dex 30 and Dex 45 groups, patients were premedicated with i.m. midazolam and atropine and oral dextromethorphan 30 mg and 45 mg, respectively. Pain was evaluated repeatedly throughout 7 postoperative days, at rest and on swallowing, using a self-rating visual analog scale (VAS). The total doses of analgesics administered postoperatively were also recorded. The Dex 45 group showed significantly lower VAS scores than the control group both at rest and on swallowing throughout the 7 days. The total doses of postoperative analgesics in the Dex 45 group were significantly less than those in the control group. The Dex 30 group showed significantly lower VAS scores than the control group at rest, but not on swallowing. These results indicate that premedication with Dex 45 reduces postoperative pain after tonsillectomy, not only at rest but on swallowing. IMPLICATIONS: Recently, it has been suggested that central sensitization caused by the activation of N-methyl-D-aspartic acid receptors may contribute to the postoperative pain. We found that premedication with 45 mg of dextromethorphan, a clinically available N-methyl-D-aspartic acid receptor antagonist, reduced postoperative pain after tonsillectomy.

Administration, Oral↗