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CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
A randomised controlled trial of two analgesic techniques for paediatric tonsillectomy*
E Rawlinson1, A Walker, R Skone
1Great Ormond Street Hospital for Children NHS Trust, London, UK.
Anaesthesia
|September 3, 2011
Summary
This study compared a fentanyl-diclofenac regimen with a codeine regimen for pediatric tonsillectomy pain. Neither regimen proved ideal for day surgery, with similar nausea and pain outcomes.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Tonsillectomy is a common pediatric surgery.
- Effective postoperative pain management and reduced postoperative nausea and vomiting (PONV) are crucial for pediatric tonsillectomy recovery.
- The modified Bristol technique (fentanyl and diclofenac) was compared to a codeine-based regimen.
Purpose of the Study:
- To compare the effectiveness of a modified Bristol analgesic technique (fentanyl and diclofenac) versus a codeine-based regimen in pediatric tonsillectomy patients.
- To evaluate and compare rates of postoperative nausea and vomiting (PONV) and pain scores between the two analgesic groups.
- To assess the suitability of both regimens for day-case tonsillectomy by evaluating fitness for discharge at 4 hours.
Main Methods:
- A randomized study involving 65 pediatric patients (ASA 1-2) undergoing tonsillectomy.
- Patients were assigned to either the Bristol group (fentanyl 1-2 μg/kg, diclofenac 1-2 mg/kg) or the codeine group (codeine 1.5 mg/kg).
- All patients received paracetamol and dexamethasone. PONV, pain scores, and fitness for discharge were assessed hourly and at 4 hours, respectively.
Main Results:
- The overall incidence of PONV was 21% with no significant difference between the Bristol (21%) and codeine (16%) groups (p = 0.29).
- Patients in the Bristol group required analgesia sooner than the codeine group (p < 0.005), but peak pain scores were similar (Bristol median 4.5, codeine median 4.0; p = 0.15).
- Twenty-three percent of children were not fit for discharge at 4 hours, indicating neither regimen is ideal for same-day surgery.
Conclusions:
- Neither the modified Bristol technique nor the codeine-based regimen appears ideally suited for day-case pediatric tonsillectomy.
- Both regimens resulted in similar rates of PONV and peak pain scores.
- Further observation may be necessary for pediatric tonsillectomy patients regardless of the analgesic regimen used.
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Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...