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Published on: November 6, 2019
Modified infiltration technique in tonsillectomy: expanded case report of 25 children
M Z Naja1, M El-Rajab, H Sidani
1Anesthesia and Pain Medicine Department, Makassed General Hospital, P.O. Box 11-6301, Riad El-Solh, Beirut 11072210, Lebanon. zouhnaja@yahoo.com
Insights
A new anesthetic infiltration technique, informed by tonsil innervation, significantly reduced post-tonsillectomy pain in children. This method led to same-day discharge and high patient satisfaction, minimizing the need for opioids.
Area of Science:
- Otolaryngology
- Anesthesiology
- Surgical Innovation
Background:
- Post-tonsillectomy pain is a significant challenge impacting patient recovery and satisfaction.
- Understanding tonsil innervation is crucial for developing effective pain management strategies.
Purpose of the Study:
- To introduce and evaluate a modified anesthetic infiltration technique for reducing post-tonsillectomy pain.
- To correlate histo-anatomic observations with tonsil innervation for precise anesthetic delivery.
Main Methods:
- Histo-anatomic study of 62 patients and nerve-stimulator detection in 20 children.
- Application of a modified infiltration technique in 25 children based on anatomical findings.
- Assessment of post-operative pain, hemodynamic stability, hospital stay, and patient satisfaction.
Main Results:
- Nerve-stimulator mapping confirmed glossopharyngeal nerve branches in the peritonsillar area.
- The modified technique resulted in minimal pain scores (median VAS < 1) and low opioid requirement (12%).
- 100% same-day discharge and 96% parent satisfaction were achieved with maintained hemodynamic stability.
Conclusions:
- The modified anesthetic infiltration technique effectively reduces post-tonsillectomy pain.
- This technique offers a promising approach for improving patient outcomes after tonsillectomy.
- Further validation through a randomized double-blinded study is warranted.
Objective:
To introduce a modified infiltration technique of anesthetic mixture in order to reduce post-tonsillectomy pain based on histo-anatomic observations and tonsil's innervation detection.
Design:
Histo-anatomic, expanded case report.
Setting:
Tertiary care facility in Beirut, Lebanon.
Patients:
One hundred and seven patients who underwent tonsillectomy allocated in three groups.
Interventions:
Histo-anatomic observations were studied in 62 patients (group I). Nerve-stimulator detection was performed in group II (20 children). An expanded case report of 25 children (group III) was conducted using a modified infiltration technique based on the findings of the histo-anatomic observations and nerve detection.
Outcome Measures:
Post-operative pain at 0, 6, 12h and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, patient satisfaction and analgesics consumption were assessed.
Results:
The nerve-stimulator confirmed the histo-anatomic findings by strong contractions of the superior constrictor muscle, soft palate and uvula when the needle is mainly in the middle part of the peritonsillar area where the glossopharyngeal nerve branches predominate. No visual analogue scale median exceeded 1 for any child at any predetermined time interval, only three children (12%) required opoiods during the follow-up period. All children (100%) were discharged the same day, only 4% of parents were unsatisfied. Hemodynamic stability was maintained during pre- and post-operation.
Conclusion:
This modified technique with minimal volume of anesthetic mixture seems to reduce post-operative pain in tonsillectomy patients; a randomized double-blinded prospective study was designed based on the findings in this initial series of children.
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