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Published on: November 6, 2019
Topical clindamycin in post-adenotonsillectomy analgesia in children: a double-blind, randomized clinical trial
Mauricio Schreiner Miura1, Catia Saleh, Marina de Andrade
1Department of Medical Surgery of Universidade Federal de Ciências da Saúde de Porto Alegre and Division of Pediatric Otorhinolaryngology at Hospital da Criança Santo Antônio, Programa de Pós-Graduação em Ciências Médicas-Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. mmiura.voy@terra.com.br
Insights
Topical clindamycin reduced throat pain after tonsillectomy in children on the first postoperative day. However, its benefits did not extend to subsequent days or other measured outcomes.
Area of Science:
- Pediatric Otolaryngology
- Surgical Pain Management
Background:
- Tonsillectomy and adenoidectomy are common pediatric procedures.
- Postoperative pain significantly impacts recovery, potentially causing dehydration.
- Effective pain management strategies are crucial for pediatric surgical patients.
Purpose of the Study:
- To evaluate the efficacy of topical clindamycin in reducing oropharyngeal pain in children undergoing adenotonsillectomy.
- To assess secondary outcomes including otalgia, analgesic use, and recovery parameters.
Main Methods:
- A double-blind, randomized clinical trial was conducted in a tertiary hospital.
- Eighty-two children (4-12 years) received topical clindamycin or placebo perioperatively.
- Oropharyngeal pain was measured using a faces pain scale for five days.
Main Results:
- Topical clindamycin significantly reduced oropharyngeal pain on the first postoperative day (P = .002).
- No significant differences were observed in pain levels on subsequent days.
- No differences were found in bacterial counts, otalgia, analgesic use, diet, bleeding, vomiting, or fever.
Conclusions:
- Topical clindamycin offers a short-term benefit for pain reduction immediately after adenotonsillectomy.
- Further research is needed to explore sustained use or alternative application timings for topical clindamycin.
Objectives:
Tonsillectomy, with or without adenoidectomy, is one of the most common surgical procedures in pediatric otolaryngology. Pain is the main cause of morbidity in the postoperative period, where it is serious in some cases, leading to odynophagia and resultant complications such as dehydration. We evaluated the effect of topical clindamycin in the reduction of oropharyngeal pain in children who underwent adenotonsillectomy. Secondary outcomes were otalgia, analgesic use, oral bacterial count, type of diet, secondary bleeding, vomiting, fever, and weight loss.
Study Design:
Double-blind, randomized clinical trial.
Setting:
Tertiary hospital.
Subjects And Methods:
Eighty-two children of both sexes between four and 12 years of age who underwent adenotonsillectomy were allocated to receive topical clindamycin or placebo in the immediate preoperative, intraoperative, and eight-to-12-hours postoperative periods. Pain was measured using a faces pain scale for five days.
Results:
Reduction of oropharyngeal pain was significant with the use of clindamycin only on the first postoperative day (95% confidence interval, 2.22 to 4.41 [clindamycin] vs 4.53 to 6.3 [placebo]; P = .002). No difference was observed in the aerobic and anaerobic counts by tongue swab between premedication and third-postoperative-day samplings. There were no differences with respect to reduction in otalgia, paracetamol use, return to normal diet, variation in weight, secondary hemorrhage, vomiting, and fever.
Conclusion:
The use of topical clindamycin was beneficial in reducing pain on the first postoperative day, without effect on subsequent days. Future investigations could examine the use of topical clindamycin not only in the first 12 hours but also during five days of follow-up.
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