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Gurmu M, Mulugeta H, Zemedkun A, Girma T, Destaw B, Tadessa M, Adamu Y, Hailu S. Postoperative analgesic effects of intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Ethiopia, 2023: a double-blind randomized controlled trial. Ann Med Surg (Lond) 2024; 86:232-239. [PMID: 38222682 PMCID: PMC10783290 DOI: 10.1097/ms9.0000000000001563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024] Open
Abstract
Background The use of cesarean section (CS) worldwide has increased to unprecedented levels. In Ethiopia, the CS delivery rate is above the rate recommended by the WHO. The postoperative pain experience is moderate to severe in most patients during their postoperative period. The administration of intravenous dexamethasone is thought to have an analgesic effect after surgery even though the analgesic profile of preoperatively administered dexamethasone is less addressed. Objective This study aimed to assess the postoperative analgesic effect of preoperative intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Southern Ethiopia. Methodology A double-blinded randomized controlled trial (RCT) was done on 112 patients undergoing elective CS under spinal anesthesia who were allocated randomly into normal saline and dexamethasone groups. Total analgesic consumption, time to first analgesic request, and postoperative pain score with the numerical rating scale (NRS) were followed for 24 h in both groups. Shapiro-Wilk tests were used to check normality. Independent samples t-test was used for the comparison of means between groups, Mann-Whitney U test for non-normally distributed data, and χ 2 test for categorical variables, and P-value <0.05 was considered statistically significant with a power of 80%. Result The finding of this study showed that the postoperative pain score of the dexamethasone group was significantly lower than the normal saline group at 2, 4, 6, 12, 18, and 24 h with a statistically significant P-value <0.05. There was also a significant difference in the time to the first rescue analgesic request between the two groups, with the dexamethasone group (median=347.5 min) and the normal saline group (median=230 min) with P=0.001. Conclusion and recommendation The authors conclude that preoperative administration of 8 mg of dexamethasone prolongs the first analgesic request time, decreases postoperative tramadol and diclofenac consumption, and decreases the postoperative pain score. The authors recommend that researchers conduct further RCTs with a different dose of dexamethasone and on a multicenter basis.
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Affiliation(s)
| | | | | | | | | | | | | | - Seyoum Hailu
- Department of Anesthesiology, Dilla University, Dilla, Ethiopia
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Pardessus P, Loiselle M, Silins V, Horlin AL, Brouns K, Marsac L, Fait C, Ilharreborde B, Julien-Marsollier F, Dahmani S. The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery. Paediatr Anaesth 2023; 33:829-836. [PMID: 37386846 DOI: 10.1111/pan.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Bleeding and transfusion remain important concerns during surgical correction of scoliosis even when multiple conservative strategies, such as preoperative recombinant erythropoietin and/or antifibrinolytic agents, are used. The current work aimed to determine the impact of other potential risk factors, especially the volume of intraoperative fluid intake, on the perioperative risk of allogenic transfusion during surgical correction of adolescent idiopathic scoliosis. METHODS This prospective study included all cases of adolescent idiopathic scoliosis operated in a single center during 2 years (2018-2020). Predictors analyzed were as follows: body mass index, preoperative hemoglobin concentration, thoracoplasty, preoperative halo-gravity, volume of intraoperative crystalloid administration, use of esophageal Doppler (for goal-directed fluid therapy), and duration of surgery. Statistical analyses were performed using a multivariable logistic regression model. RESULTS Two hundred patients were included in the analysis. Multivariable analysis found: an increased volume of intraoperative crystalloid administration as a significant predictor of allogenic blood transfusion. Receiving operator characteristics analysis found the model exhibiting an area under the curve of 0.85 (95% confidence interval: 0.75-0.95). Optimizing stroke volume using esophageal Doppler was associated with a decrease in intraoperative crystalloid intake. CONCLUSION These results indicate a statistical association between the increase in crystalloid intake and the risk of allogenic blood transfusion during surgical correction of adolescent idiopathic scoliosis. Controlled studies are needed to address the causative relation between intraoperative fluid intake and the risk of allogenic transfusion.
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Affiliation(s)
- Pierre Pardessus
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Maud Loiselle
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Vilnis Silins
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Anne-Laure Horlin
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Kelly Brouns
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Lucile Marsac
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Charlotte Fait
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Brice Ilharreborde
- Université de Paris-Cité, Paris, France
- FHU I2D2. Robert Debré Hospital, Paris, France
- Department of orthopedic surgery, Robert Debré Hospital, Paris, France
| | - Florence Julien-Marsollier
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
- FHU I2D2. Robert Debré Hospital, Paris, France
| | - Souhayl Dahmani
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
- FHU I2D2. Robert Debré Hospital, Paris, France
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Malhotra V, Kumar V. Effect of Preoperative Dexamethasone on Postoperative Pain in Patients Undergoing Tonsillectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:249-254. [PMID: 37275095 PMCID: PMC10235390 DOI: 10.1007/s12070-022-03195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/23/2022] [Indexed: 06/07/2023] Open
Abstract
Tonsillectomy is one of the most commonly performed surgical procedures worldwide. Postoperative pain remains a significant problem for patients undergoing tonsillectomy and is the most typical reason for readmission after the procedure. We conducted the present study to investigate the efficacy of a single dose of dexamethasone administered intravenously before tonsillectomy on postoperative pain in a group of patients undergoing cold dissection tonsillectomy, using a standardised anaesthetic and surgical procedure.It was a prospective study done in the Department of ENT in a tertiary care centre in eastern India, from 1 st September 2017 to 31 st August 2019 (2 years). Subjects included in the study were patients who attended the OPD of ENT of the tertiary care centre in eastern India, with a history of throat pain,difficulty in deglutition, mouth breathing, snoring. Tonsillectomy operation was recommended to the patients who fit the inclusion criteria. A hundred patients were selected for the study and divided randomly into two groups. Patients in group A (50 patients) were administered preoperative intravenous dexamethasone (0.15 mg/kg)after the induction of anaesthesia, and Group B patients (50 patients)were not administered dexamethasone along with other drugs.RESULTS: A hundred patients were enrolled after excluding the patients not fulfilling the selection criteria. The majority of patients were female, with the majority patients between 9-19 years. There was a noteworthy decreased mean pain score postoperatively of Group A on the first, third, and fifth day. (p-value = < 0.001).The results of this study suggest that a single preoperative injection of dexamethasone for patients undergoing tonsillectomy by cold dissection method significantly reduced postoperative pain.
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Affiliation(s)
- Vibhor Malhotra
- MS ENT, Otology & Hearing Implant Fellow Apollo Bannerghatta, Bangalore, India
| | - Vivek Kumar
- MS, DNB ENT, Department Of ENT PMCH, Patna, India
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Curtis SH, Thorne MC. Comparison of high-versus low-dose corticosteroid administration on post-tonsillectomy outcomes. Int J Pediatr Otorhinolaryngol 2023; 165:111434. [PMID: 36599207 DOI: 10.1016/j.ijporl.2022.111434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/27/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Intraoperative steroids have been shown to decrease post-tonsillectomy morbidity; however, optimal dosing of corticosteroids is unknown. This study evaluates the effects of high-versus low-dose dexemethasone administration (0.5 mg/kg vs. 0.1 mg/kg) on post-tonsillectomy outcomes. STUDY DESIGN Nonrandomized controlled study. SETTING Academic Medical Center. METHODS Pediatric patients undergoing tonsillectomy at the University of Michigan between 2017 and 2018 were identified. Uncomplicated patients between 1 and 18 years who received dexamethasone during their operation were included. Patients were categorized by high- or low-dose dexamethasone administration and outcomes assessed included revisits within 30 days for pain, vomiting/dehydration, and post-operative bleeding. The number of postoperative phone calls was also assessed. RESULTS A total of 1641 patients were included in the study. No significant differences in steroid group outcomes were observed regarding vomiting (1.65% vs 1.7%, p = 0.618), bleeding (1.09% vs 1.3%, p = 0.579), pain (1.64% vs 0.62%, p = 0.141), other morbidities (3.83% vs 3.57%, p = 0.493) or post-operative phone calls (10.6% vs 9.9%, p = 0.81). Post-tonsillectomy bleeding was higher for infectious etiology versus sleep disordered breathing (p = 0.005); however, no rate differences for vomiting or pain were noted. Controlling for indication, no differences in hospital return rates were seen between steroid groups. CONCLUSIONS No statistically significant differences in post-tonsillectomy outcome measures were observed based on administration of either high- or low-dose dexamethasone. With no observed outcome differences related to steroid dosing, we transitioned to routine use of low-dose dexamethasone for tonsillectomy and adenoidectomy.
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Affiliation(s)
- Stuart H Curtis
- Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA; Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Marc C Thorne
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
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Sarkar S, Parthiban M, Haritha D, Ray BR, Singh AK, Kumar S, Khanna P, Kashyap L. Impact of intravenous dexamethasone on the initiation and recovery of atracurium in children: A double-blinded randomized controlled trial. Paediatr Anaesth 2023; 33:123-128. [PMID: 36268789 DOI: 10.1111/pan.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chronic steroid intake has been associated with attenuation of neuromuscular block. Despite some promising animal and adult studies, the effect of a single dose of intravenous dexamethasone on neuromuscular blockers is not well established. Thus, the present study aimed to demonstrate the effect of dexamethasone given at the time of induction for the prevention of PONV on the action of neuromuscular blockers in children undergoing elective surgery. METHOD After obtaining approval from the Institute Ethics Committee and written informed parental consent, 100 ASA I and II children aged 4-15 years undergoing elective surgery randomized to receive either: 0.15 mg/kg (maximum of 5 mg) of dexamethasone diluted to a total volume of 2 ml with 0.9% saline (n = 50) or 2 ml of 0.9% saline (n = 50) at the time of induction. The time interval between application of atracurium and maximum T1 depression, 25% twitch height recovery of T1, amid 25% and 75% twitch height recovery of T1, amid the 25% twitch height recovery of T1 and recovery of the neuromuscular block to a TOF ratio of 0.9, and in between the initiation of atracurium injection till the recovery of the neuromuscular block to a TOF ratio of 0.9 was defined as onset time, clinical duration, recovery index, recovery time, and total recovery period, respectively, and recorded. RESULTS The onset time and recovery index time were lower (1.96 ± 0.39, 8.04 ± 2.14, respectively) with dexamethasone in comparison with saline (2.01 ± 0.51, 8.9 ± 3.4, respectively) but not statistically significant. The clinical duration, recovery time, and total recovery period were similar. CONCLUSION Application of a single bolus dose (0.15 mg/kg) of dexamethasone during induction does not attenuate atracurium-induced neuromuscular blockade in children.
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Affiliation(s)
- Soumya Sarkar
- Department of Anesthesiology & Critical Care, AIIMS, Bhubaneswar, India
| | - Magesh Parthiban
- Department of Anaesthesiology & Critical Care, JIPMER, Puducherry, India
| | - Damarla Haritha
- Department of Anaesthesiology Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Bikash Ranjan Ray
- Department of Anaesthesiology Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Akhil Kant Singh
- Department of Anaesthesiology Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Shailendra Kumar
- Department of Anaesthesiology Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesiology Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Lokesh Kashyap
- Department of Anaesthesiology Pain Medicine & Critical Care, AIIMS, New Delhi, India
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[Postoperative nausea and vomiting-recommendations for its prevention and therapy in paediatric medicine]. DIE ANAESTHESIOLOGIE 2023; 72:37-47. [PMID: 36602557 DOI: 10.1007/s00101-022-01248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Post-operative nausea and/or vomiting (PONV/POV) are among the biggest problems occurring in the paediatric recovery room and in the course of the following post-operative period. Apart from pain and emergence delirium, PONV is one of the main causes of post-operative discomfort in children. The DGAI Scientific Working Group on Paediatric Anaesthesia already worked out recommendations for the prevention and treatment of PONV in children years ago. These recommendations have now been revised by a team of experts, the current literature has been reviewed, and evidence-based core recommendations have been consented. Key elements of the new recommendations consist of effective individual measures for prevention and therapy, next to the implementation of a fixed dual prophylaxis in the clinical routine applicable to all children ≥ 3 years of age.
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Tesoro S, Gamba P, Bertozzi M, Borgogni R, Caramelli F, Cobellis G, Cortese G, Esposito C, Gargano T, Garra R, Mantovani G, Marchesini L, Mencherini S, Messina M, Neba GR, Pelizzo G, Pizzi S, Riccipetitoni G, Simonini A, Tognon C, Lima M. Pediatric robotic surgery: issues in management-expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP). Surg Endosc 2022; 36:7877-7897. [PMID: 36121503 PMCID: PMC9613560 DOI: 10.1007/s00464-022-09577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally. METHODS A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place. RESULTS During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management. CONCLUSION Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.
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Affiliation(s)
- Simonetta Tesoro
- Division of Anesthesia, Analgesia, and Intensive Care, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy.
| | - Mirko Bertozzi
- Department of Pediatric Surgery, IRCCS San Matteo Polyclinic, University of Pavia, Pavia, Italy
| | - Rachele Borgogni
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Fabio Caramelli
- Anesthesia and Intensive Care Unit, IRCCS Sant'Orsola Polyclinic, Bologna, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Polytechnical University of Marche, Ancona, Italy
| | - Giuseppe Cortese
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Tommaso Gargano
- Pediatric Surgery Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
| | - Rossella Garra
- Institute of Anesthesia and Intensive Care, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giulia Mantovani
- Pediatric Anesthesia, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Laura Marchesini
- Division of Anesthesia, Analgesia, and Intensive Care, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Simonetta Mencherini
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS San Matteo Polyclinic, Pavia, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Santa Maria Alle Scotte Polyclinic, University of Siena, Siena, Italy
| | - Gerald Rogan Neba
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Vittore Buzzi' Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Simone Pizzi
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery, IRCCS San Matteo Polyclinic, University of Pavia, Pavia, Italy
| | - Alessandro Simonini
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Costanza Tognon
- Pediatric Anesthesia, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Mario Lima
- Pediatric Surgery Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
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Yang Y, Cao J, Chen X, Liu D, Lv Q, Ma J, Zhang Y, Song X. Perioperative pain management based on enhanced recovery after surgery in children undergoing adenotonsillectomy: A prospective, randomized controlled trial. Laryngoscope Investig Otolaryngol 2022; 7:1634-1642. [PMID: 36258845 PMCID: PMC9575122 DOI: 10.1002/lio2.910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/21/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pain management, as a key component of enhanced recovery after surgery (ERAS), can effectively relieve perioperative pain and anxiety. However, there are few studies on the application of pain management based on ERAS in pediatric surgery patients. We aimed to examine the effect of ERAS‐based perioperative pain management in children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy. Methods From March 2021 to July 2021, a randomized controlled single‐blind study was conducted on children with OSA and scheduled to undergo adenotonsillectomy. The children were randomly assigned to either control group (n = 60) or ERAS group (n = 60). Traditional analgesia measures were provided to children in the control group, whereas ERAS‐based optimized analgesia measures were provided to children in the ERAS group. The pain scores, anxiety scores and diet quality scores were compared between the two groups. Results The pain scores after surgery in the ERAS group were significantly lower than those in the control group at 6 h, 1 day, 3 days, and 5 days after surgery. Furthermore, the diet quality scores in the ERAS group were significantly higher than those in the control group at 6 h, 1 day, 3 days, and 5 days after surgery. The anxiety scores after surgery in the ERAS group were significantly lower than those in the control group. Conclusions Perioperative pain management based on ERAS can significantly alleviate postoperative pain, improve quality of life, and promote the accelerated rehabilitation of children with OSA undergoing adenotonsillectomy. Level of evidence 1.
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Affiliation(s)
- Yujuan Yang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital Qingdao University Yantai China
| | - Jiayu Cao
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital Qingdao University Yantai China
| | - Xiumei Chen
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases Yantai China
| | - Dawei Liu
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital Qingdao University Yantai China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases Yantai China
| | - Qiaoying Lv
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital Qingdao University Yantai China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases Yantai China
| | - Jiahai Ma
- Department of Anesthesiology, Yantai Yuhuangding Hospital Qingdao University Yantai China
| | - Yu Zhang
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases Yantai China
| | - Xicheng Song
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital Qingdao University Yantai China
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Shih MC, Long BD, Pecha PP, White DR, Liu YC, Brennan E, Nguyen MI, Clemmens CS. A scoping review of randomized clinical trials for pain management in pediatric tonsillectomy and adenotonsillectomy. World J Otorhinolaryngol Head Neck Surg 2022; 9:9-26. [PMID: 37006744 PMCID: PMC10050970 DOI: 10.1002/wjo2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives To examine the volume, topics, and reporting trends in the published literature of randomized clinical trials for pharmacologic pain management of pediatric tonsillectomy and adenotonsillectomy and to identify areas requiring further research. Data Sources PubMed (National Library of Medicine and National Institutes of Health), Scopus (Elsevier), CINAHL (EBSCO), and Cochrane Library (Wiley). Methods A systematic search of four databases was conducted. Only randomized controlled or comparison trials examining pain improvement with a pharmacologic intervention in pediatric tonsillectomy or adenotonsillectomy were included. Data collected included demographics, pain-related outcomes, sedation scores, nausea/vomiting, postoperative bleeding, types of drug comparisons, modes of administration, timing of administration, and identities of the investigated drugs. Results One hundred and eighty-nine studies were included for analysis. Most studies included validated pain scales, with the majority using visual-assisted scales (49.21%). Fewer studies examined pain beyond 24 h postoperation (24.87%), and few studies included a validated sedation scale (12.17%). Studies have compared several different dimensions of pharmacologic treatment, including different drugs, timing of administration, modes of administration, and dosages. Only 23 (12.17%) studies examined medications administered postoperatively, and only 29 (15.34%) studies examined oral medications. Acetaminophen only had four self-comparisons. Conclusion Our work provides the first scoping review of pain and pediatric tonsillectomy. With drug safety profiles considered, the literature does not have enough data to determine which treatment regimen provides superior pain control in pediatric tonsillectomy. Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of posttonsillectomy pain. The heterogeneity in study design and comparisons weakens the conclusions of potential systematic reviews and meta-analyses. Future directions include more noninferiority studies of unique comparisons and more studies examining oral medications given postoperatively.
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Affiliation(s)
- Michael C. Shih
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
- Baylor College of Medicine Houston Texas USA
| | - Barry D. Long
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
- Department of Otolaryngology—Head and Neck Surgery Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Phayvanh P. Pecha
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - David R. White
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - Yi‐Chun C. Liu
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
- Department of Surgery ‐ Division of Pediatric Otolaryngology Texas Children's Hospital Houston Texas USA
| | - Emily Brennan
- Department of Research and Education Services Medical University of South Carolina Library Charleston South Carolina USA
| | - Mariam I. Nguyen
- Charleston County School of the Arts North Charleston South Carolina USA
| | - Clarice S. Clemmens
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
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de Azevedo CB, Valera FCP, Carenzi LR, Küpper DS, Caetano JVB, Queiroz DLC, Anselmo-Lima WT, Tamashiro E. Does ibuprofen, prednisolone, or amoxicillin reduce post-tonsillectomy pain in children? A prospective randomized controlled trial. Int J Pediatr Otorhinolaryngol 2021; 148:110824. [PMID: 34229149 DOI: 10.1016/j.ijporl.2021.110824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/19/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate whether the use of anti-inflammatory or antibiotic in the postoperative period modifies pain in children undergoing tonsillectomy. METHODS 225 children who underwent cold knife tonsillectomy ± adenoidectomy were randomized into five groups, receiving #1 metamizole/acetaminophen, #2 amoxicillin, #3 ibuprofen, #4 prednisolone, or #5 amoxicillin plus prednisolone. All groups received oral analgesics (metamizole/acetaminophen) to use as needed. Pain was monitored during the 7 days following surgery using the Parents' Postoperative Pain Measurement (PPPM) and the Faces Pain Scale - Revised (FPS-R). Pain was also indirectly evaluated by the dose of analgesics administered on each day and by the time needed to return to a solid diet. RESULTS After losses (24%), 170 individuals were submitted for analysis. Multiple comparisons demonstrated that the evolution of pain between the different groups, as matched day-per-day, was not significantly different by either PPPM or FPS-R (p > 0.05). The instances of analgesic intake were also similar in all the groups (p > 0.05), as was the return to solid food ingestion (p = 0.41). All groups presented a similar standard of clinical improvement at intervals of 2 days (p < 0.01). Independent of postoperative pain management, patients developed significant pain up to the day 4 following surgery. CONCLUSION The addition of amoxicillin, ibuprofen, prednisolone, or amoxicillin and prednisolone does not modify postoperative pain in children undergoing cold-knife tonsillectomy. Special pain control should be performed on the first 4 days following tonsillectomy in children.
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Affiliation(s)
| | - Fabiana C P Valera
- Ribeirao Preto Medical School, University of São Paulo (FMRP-USP), Brazil.
| | | | - Daniel S Küpper
- Ribeirao Preto Medical School, University of São Paulo (FMRP-USP), Brazil.
| | | | | | | | - Edwin Tamashiro
- Ribeirao Preto Medical School, University of São Paulo (FMRP-USP), Brazil.
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11
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Jensen DR. Pharmacologic management of post-tonsillectomy pain in children. World J Otorhinolaryngol Head Neck Surg 2021; 7:186-193. [PMID: 34430826 PMCID: PMC8356107 DOI: 10.1016/j.wjorl.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 12/19/2022] Open
Abstract
Tonsillectomy is a very common procedure in children, often performed on an outpatient basis. Severe postoperative pain is common, and can be prolonged. Despite a large number of available analgesic medications, often employed in combination, achieving adequate pain control remains a persistent challenge. Research suggests a tendency among caregivers to undertreat pain, and a need for detailed care instructions and education to ensure adequate pain management. Furthermore, ongoing questions regarding the safety and efficacy of the most commonly used medications have led to wide variance in practice patterns and continuous reassessment through research that yields sometimes conflicting results. This review summarizes the current state of the literature and presents a management approach which attempts to maximize pain control while minimizing potential harm with combinations of medications and modification based on patient-specific factors.
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Affiliation(s)
- Daniel R. Jensen
- Division of Otolaryngology, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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12
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Julien-Marsollier F, Assaker R, Michelet D, Camby M, Galland A, Marsac L, Vacher T, Simon AL, Ilharreborde B, Dahmani S. Effects of opioid-reduced anesthesia during scoliosis surgery in children: a prospective observational study. Pain Manag 2021; 11:679-687. [PMID: 34102877 DOI: 10.2217/pmt-2020-0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: Opioid-reduced anesthesia (ORA) was suggested to decrease morphine consumption after adolescent idiopathic scoliosis (AIS) surgery and incidence of chronic pain. Materials & methods: A prospective analysis using the ORA in AIS surgery was performed. Two cohorts were compared: a control group (opioid-based anesthesia) and the ORA group. The main outcome was morphine consumption at day 1. Results: 33 patients operated for AIS using ORA were compared with 36 with opioid-based anesthesia. Morphine consumption was decreased in the ORA group (1.1 mg.kg-1 [0.2-2] vs 0.8 mg.kg-1 [0.3-2]; p = 0.02) at day 1. Persistent neuropathic pain at 1 year was decreased in the ORA group (p = 0.02). Conclusion: The ORA protocol is efficient to reduce postoperative morphine consumption in AIS surgery and preventing neuropathic pain.
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Affiliation(s)
- Florence Julien-Marsollier
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Rita Assaker
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Daphné Michelet
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Matthieu Camby
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Anne Galland
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Lucile Marsac
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Thomas Vacher
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Anne-Laure Simon
- Université de Paris, Paris, France.,Department of Orthopedic Surgery, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Brice Ilharreborde
- Université de Paris, Paris, France.,Department of Orthopedic Surgery, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Souhayl Dahmani
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
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13
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Kubala ME, Turner M, Gardner JR, Williamson A, Richter GT. Impact of Oral Steroids on Tonsillectomy Postoperative Complications and Pain. EAR, NOSE & THROAT JOURNAL 2021; 102:NP206-NP211. [PMID: 33734886 DOI: 10.1177/01455613211000832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To analyze the impact of steroids on postoperative tonsillectomy recovery and implement findings for improvement in postoperative management. METHODS Institutional review board approved prospective study with retrospective analysis of private practice setting tonsillectomy patients (November 2015 to January 2017). A questionnaire was provided postoperatively to patients undergoing tonsillectomy with or without adenoidectomy. The study population was separated into 2 groups: patients who received steroids (3 days of either dexamethasone or prednisolone), postoperative steroid (POS), versus patients who did not receive steroids (PONS). RESULTS The questionnaire had a return rate of 27.3% (254/931). Nine of the 254 responses were disqualified for lack of information; therefore, the total number of responses was 245. Of these, 115 were POS and 130 were PONS. The groups were similar in mean age (POS: 13.2 ± 10.4 years, PONS: 14.7 ± 12.1 years, P = .32) and sex (POS: Male 40.0%, PONS: Male 40.0%, P = .97). There was an overall decrease of pain and nausea/vomiting (N/V) in the steroid group (P = .0007). There was reduction in pain (P < .05) from postoperative day (POD) 2, 3, 4, and 6 in the POS group. Otherwise, there was no significant reduction in pain from POD 7 to 14, day-by-day rate of N/V, bleeding, or rate of emergency department (ED) or clinic visit (P > .05). CONCLUSION Postoperative steroid reduced overall pain and N/V, as well as daily pain on POD 2, 3, 4, and 6. Pain from POD 7 to 14, rate of ED or clinic visit, or daily N/V and bleeding rate were not significantly different between cohorts.
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Affiliation(s)
- Michael E Kubala
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Merit Turner
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Adrian Williamson
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Otolaryngology Centers, Little Rock, AR, USA
| | - Gresham T Richter
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, AR, USA
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14
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Nasal Sprays Containing Mometasone Furoate for Relief of Post-Adenotonsillectomy Pain in Children: A Prospective Controlled Study. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:101-107. [PMID: 33935543 PMCID: PMC8085455 DOI: 10.14744/semb.2020.75735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/10/2020] [Indexed: 11/20/2022]
Abstract
Objectives Adenotonsillectomy is one of most common surgeries performed in childhood. Post-operative pain associated particularly with tonsillectomy is still a problem for many physicians. Despite advances in surgical techniques, analgesics, or anti-inflammatory drugs, no unique strategy for post-tonsillectomy pain management has been suggested. The aim of this study is to investigate the analgesic effect of steroid containing nasal spray applied to tonsillar region after tonsillectomy. Methods Eighty-two patients were assigned into two groups as study and control. In study group, nasal spray containing steroid was applied to each tonsillar region after surgery for 5 days. Post-operative pain of all patients was assessed using a visual analog scale and results were compared. Results Pain decreased gradually over time in both the study and control groups. Although the pain scores from 4 h post-surgery to post-operative day 5 were not found to significantly decrease in children that used nasal spray containing steroid, these patients developed less pain on post-operative day 5,with statistical significance (p<0.05). Conclusion Post-tonsillectomy pain was reported to increase around post-operative day 5, which coincides with the time of intense wound inflammation. Therefore, significant pain reduction on post-operative day 5 observed in children that used nasal spray with steroid may have clinical importance for overcoming this problem.
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Abstract
Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.
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Affiliation(s)
- Anthony L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA.
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16
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Aldamluji N, Burgess A, Pogatzki-Zahn E, Raeder J, Beloeil H. PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020; 76:947-961. [PMID: 33201518 PMCID: PMC8247026 DOI: 10.1111/anae.15299] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure‐specific efficacy as well as specific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta‐analysis guidelines with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol; non‐steroidal anti‐inflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non‐steroidal anti‐inflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra‐operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the first‐line analgesics are contra‐indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.
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Affiliation(s)
- N Aldamluji
- Department of Adult Anaesthesiology, Sidra Medicine, Qatar
| | - A Burgess
- Department of Otolaryngology Head and Neck Surgery, Com Maillot-Hartmann Private Hospital, Neuilly sur Seine, France
| | - E Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - J Raeder
- Department of Anaesthesiology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H Beloeil
- Department of Anaesthesiology and Critical Care, Université Rennes, Rennes, France
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17
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Julien-Marsollier F, Michelet D, Assaker R, Doval A, Louisy S, Madre C, Simon AL, Ilharreborde B, Brasher C, Dahmani S. Enhanced recovery after surgical correction of adolescent idiopathic scoliosis. Paediatr Anaesth 2020; 30:1068-1076. [PMID: 32750176 DOI: 10.1111/pan.13988] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few publications in the literature examine enhanced recovery after scoliosis surgery (ERAS) in children, despite significant scientific interest in adults. The objective of the current study was to describe an ERAS protocol for surgical correction of adolescent idiopathic scoliosis (AIS) and its results. METHODS ERAS outcomes were measured in two patient cohorts. Historical controls and ERAS groups were selected from patients managed for scoliosis surgery in 2015 and 2018, respectively. The ERAS protocol included fasting minimization, carbohydrate loading, the avoidance of background morphine infusions, perioperative opioid-sparing protocols, the use of a cooling brace, early physiotherapy, feeding and oral medications, and the early removal of urinary catheters and surgical drains. The main outcome of the study was hospital length of stay. RESULTS Overall, 82 controls and 81 ERAS patients were recruited. ERAS protocols were observed in over 80% of patients for almost items. Median length of hospital stay was significantly lower in the ERAS group (- 3 [95% confidence interval: -2; -4] days). Median morphine consumption was reduced by 25% and 35% on days 2 and 3, respectively. The incidence of PONV did not differ between the two groups, and the incidence of constipation decreased slightly but significantly in the ERAS group on day 2. Pain intensity at rest and movement were lower in the ERAS group at day 2 and 3. CONCLUSIONS The current study suggests an ERAS protocol after adolescent idiopathic scoliosis surgery is associated with reduced hospital length of stay and improved postoperative care.
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Affiliation(s)
- Florence Julien-Marsollier
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Daphné Michelet
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Rita Assaker
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Antoine Doval
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Simon Louisy
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | | | - Anne-Laure Simon
- Department of Orthopaedic Surgery, Robert Debré Hospital, Paris, France
| | | | - Christopher Brasher
- Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.,Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, Vic., Australia
| | - Souhayl Dahmani
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
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18
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Demidovich T, Perez-Franco O, Silvestrini-Suarez M, Yue P. Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure. J Pediatr Pharmacol Ther 2020; 25:303-308. [PMID: 32461743 DOI: 10.5863/1551-6776-25.4.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Postoperative nausea and vomiting (PONV) is an extremely common side effect of general anesthesia that is difficult to manage. We tested a hypothesis that an aggressive prophylactic intervention with additional antiemetic drugs will reduce the incidence of PONV in a high-risk pediatric population undergoing adenotonsillectomy. METHODS In this retrospective study, pediatric patients undergoing adenotonsillectomy were screened for their risk factors for PONV. Patients who had 3 or more risk factors were identified as high risk and received either scopolamine patch preoperatively (for patients over 40 kg body weight) or diphenhydramine immediately postextubation in addition to ondansetron and dexamethasone, which are given routinely. Incidences of PONV within the first 60 minutes of a postanesthesia care unit (PACU) stay were collected and analyzed. RESULTS Overall postoperative vomiting rates during the first hour of a PACU stay were 4.3% for the group that was treated with dexamethasone and ondansetron only and 3.9% for the group that was treated with additional antiemetic drugs. Aggressive prophylactic management of PONV did reduce the rate of nausea and vomiting in a group of high-risk patients (p < 0.0001). The postoperative antiemetic drug usage was also decreased during the first 60 minutes of a PACU stay. However, the approach did not reduce the overall rate of PONV for the entire study population (p = 0.1612 for nausea and p = 0.0678 for vomiting). CONCLUSION Aggressive intraoperative management of PONV with additional antiemetic drugs are beneficial in high-risk pediatric population. Intraoperative diphenhydramine usage decreased the rate of PONV. However, preoperative scopolamine patch prevention did not improve PONV, which may be related to the drug's longer onset of action. Our result suggests that current clinical practice is undertreating PONV in pediatric patients receiving general anesthesia.
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19
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Frelich M, Divák J, Vodička V, Bebej M, Sklienka P, Nedopílková O. Dexamethasone for postadenoidectomy pain reduction. Does it truly work? A prospective randomized double-blind clinical trial. J Clin Anesth 2020; 61:109634. [DOI: 10.1016/j.jclinane.2019.109634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
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20
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King A, Elmaraghy C, Lind M, Tobias JD. A review of dexamethasone as an adjunct to adenotonsillectomy in the pediatric population. J Anesth 2020; 34:445-452. [PMID: 32193715 DOI: 10.1007/s00540-020-02758-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/07/2020] [Indexed: 12/22/2022]
Abstract
Although one of the most commonly performed surgical procedures in children and frequently performed as outpatient surgery, the postoperative course following tonsillectomy may include nausea, vomiting, poor oral intake, and pain. These problems may last days into the postoperative course. Although opioids may be used to treat the pain, comorbid conditions such as obstructive sleep apnea may mandate limiting the dose and the frequency of administration. Adjunctive agents may improve the overall postoperative course of patients and limit the need for opioid analgesics. Dexamethasone is a frequently administered intraoperatively as an adjunctive agent to decrease inflammation and pain, limit the potential for postoperative nausea and vomiting, and improve the overall postoperative course. The following manuscript reviews the use of dexamethasone to improve outcomes following tonsillectomy or adenotonsillectomy, discusses the controversies regarding its potential association with perioperative bleeding, and investigates options for dosing regimens which may maintain the beneficial physiologic effects while limiting the potential for bleeding.
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Affiliation(s)
- Adele King
- Department of Anesthesiology, Royal Hospital for Children, Glasgow, UK.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Charles Elmaraghy
- Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Meredith Lind
- Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. .,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
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Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, Lloyd RM, Parikh SR, Shulman ST, Walner DL, Walsh SA, Nnacheta LC. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg 2019; 160:S1-S42. [PMID: 30798778 DOI: 10.1177/0194599818801757] [Citation(s) in RCA: 271] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This update of a 2011 guideline developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children <15 years of age based on the most recent published data. This guideline is intended for all clinicians in any setting who interact with children who may be candidates for tonsillectomy. PURPOSE The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing children under consideration for tonsillectomy and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to educate clinicians, patients, and/or caregivers regarding the indications for tonsillectomy and the natural history of recurrent throat infections. Additional goals include the following: optimizing the perioperative management of children undergoing tonsillectomy, emphasizing the need for evaluation and intervention in special populations, improving the counseling and education of families who are considering tonsillectomy for their children, highlighting the management options for patients with modifying factors, and reducing inappropriate or unnecessary variations in care. Children aged 1 to 18 years under consideration for tonsillectomy are the target patient for the guideline. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of nursing, anesthesiology, consumers, family medicine, infectious disease, otolaryngology-head and neck surgery, pediatrics, and sleep medicine. KEY ACTION STATEMENTS The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should recommend watchful waiting for recurrent throat infection if there have been <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years. (2) Clinicians should administer a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy. (3) Clinicians should recommend ibuprofen, acetaminophen, or both for pain control after tonsillectomy. The guideline update group made recommendations for the following KASs: (1) Clinicians should assess the child with recurrent throat infection who does not meet criteria in KAS 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergies/intolerance, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis), or history of >1 peritonsillar abscess. (2) Clinicians should ask caregivers of children with obstructive sleep-disordered breathing and tonsillar hypertrophy about comorbid conditions that may improve after tonsillectomy, including growth retardation, poor school performance, enuresis, asthma, and behavioral problems. (3) Before performing tonsillectomy, the clinician should refer children with obstructive sleep-disordered breathing for polysomnography if they are <2 years of age or if they exhibit any of the following: obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses. (4) The clinician should advocate for polysomnography prior to tonsillectomy for obstructive sleep-disordered breathing in children without any of the comorbidities listed in KAS 5 for whom the need for tonsillectomy is uncertain or when there is discordance between the physical examination and the reported severity of oSDB. (5) Clinicians should recommend tonsillectomy for children with obstructive sleep apnea documented by overnight polysomnography. (6) Clinicians should counsel patients and caregivers and explain that obstructive sleep-disordered breathing may persist or recur after tonsillectomy and may require further management. (7) The clinician should counsel patients and caregivers regarding the importance of managing posttonsillectomy pain as part of the perioperative education process and should reinforce this counseling at the time of surgery with reminders about the need to anticipate, reassess, and adequately treat pain after surgery. (8) Clinicians should arrange for overnight, inpatient monitoring of children after tonsillectomy if they are <3 years old or have severe obstructive sleep apnea (apnea-hypopnea index ≥10 obstructive events/hour, oxygen saturation nadir <80%, or both). (9) Clinicians should follow up with patients and/or caregivers after tonsillectomy and document in the medical record the presence or absence of bleeding within 24 hours of surgery (primary bleeding) and bleeding occurring later than 24 hours after surgery (secondary bleeding). (10) Clinicians should determine their rate of primary and secondary posttonsillectomy bleeding at least annually. The guideline update group made a strong recommendation against 2 actions: (1) Clinicians should not administer or prescribe perioperative antibiotics to children undergoing tonsillectomy. (2) Clinicians must not administer or prescribe codeine, or any medication containing codeine, after tonsillectomy in children younger than 12 years. The policy level for the recommendation about documenting recurrent throat infection was an option: (1) Clinicians may recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year, at least 5 episodes per year for 2 years, or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and ≥1 of the following: temperature >38.3°C (101°F), cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus. DIFFERENCES FROM PRIOR GUIDELINE (1) Incorporating new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply. (2) There were 1 new clinical practice guideline, 26 new systematic reviews, and 13 new randomized controlled trials included in the current guideline update. (3) Inclusion of 2 consumer advocates on the guideline update group. (4) Changes to 5 KASs from the original guideline: KAS 1 (Watchful waiting for recurrent throat infection), KAS 3 (Tonsillectomy for recurrent infection with modifying factors), KAS 4 (Tonsillectomy for obstructive sleep-disordered breathing), KAS 9 (Perioperative pain counseling), and KAS 10 (Perioperative antibiotics). (5) Seven new KASs: KAS 5 (Indications for polysomnography), KAS 6 (Additional recommendations for polysomnography), KAS 7 (Tonsillectomy for obstructive sleep apnea), KAS 12 (Inpatient monitoring for children after tonsillectomy), KAS 13 (Postoperative ibuprofen and acetaminophen), KAS 14 (Postoperative codeine), and KAS 15a (Outcome assessment for bleeding). (6) Addition of an algorithm outlining KASs. (7) Enhanced emphasis on patient and/or caregiver education and shared decision making.
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Affiliation(s)
| | | | - Stacey L Ishman
- 3 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Sarah Coles
- 5 University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Sandra A Finestone
- 6 Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | | | - Terri Giordano
- 8 Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Tae W Kim
- 10 University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Robin M Lloyd
- 11 Mayo Clinic Center for Sleep Medicine, Rochester, Minnesota, USA
| | | | - Stanford T Shulman
- 13 Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David L Walner
- 14 Advocate Children's Hospital, Park Ridge, Illinois, USA
| | - Sandra A Walsh
- 6 Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Lorraine C Nnacheta
- 15 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Dexamethasone Reduces Postoperative Nausea in Pediatric Upper Endoscopy With Deep Sedation: A Randomized Controlled Trial. J Pediatr Gastroenterol Nutr 2019; 69:281-286. [PMID: 31124887 DOI: 10.1097/mpg.0000000000002398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We aimed to evaluate the effect of a single dose of preoperative dexamethasone on postoperative nausea and vomiting (PONV), a frequent complication and a major cause of delayed recovery in pediatric upper gastrointestinal endoscopy (UGIE) under sedation. METHODS In this double-blind randomized controlled study, 98 children aged 2 to 14, with American Society of Anesthesiologists status I to II, and undergoing elective UGIE with deep sedation were included and randomly assigned to 2 groups. Preoperatively, after anesthesia induction with sodium thiopental and maintenance with sevoflurane, patients in the intervention (n = 49) and control (n = 49) groups, respectively received 0.1 mg/kg i.v. dexamethasone and 2 cm i.v. 0.9% saline. Postoperatively, PONV incidence was measured as the primary outcome. RESULTS PONV incidence was significantly less in dexamethasone group (8.2%) compared to the control group (26.5%) (difference = 18.3%, 95% confidence interval: 3.4%-33%, P = 0.016). For secondary outcomes, between-group differences were not statistically significant: incidence of bronchospasm or laryngospasm (both 4.1%, P = 1); emergence delirium assessed with Pediatric Anesthesia Emergence Delirium scale (5.9 ± 3.4 vs 5.7 ± 3.2, P = 0.751); Modified Aldrete score at 0 minutes (9.4 ± 0.8 vs 9.3 ± 0.9, P = 0.909) and at 5 minutes (9.5 ± 0.7 vs 9.4 ± 0.9, P = 0.527); and recovery time (21.1 ± 6.6 vs 23.4 ± 8.6 minutes, P = 0.130). CONCLUSIONS A single preoperative dose of i.v. dexamethasone reduces PONV in children undergoing elective UGIE with deep sedation, but has no significant effect on the patient recovery time or the incidence of postoperative bronchospasm or laryngospasm and emergence delirium.
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Elsonbaty M, E lsonbaty A. Effect of intravenous magnesium sulphate or dexamethasone as adjuvants to sevoflurane anesthesia to prevent delirium during primary cleft palate repair, controlled randomized blind study. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Effects of prophylactic dexamethasone on postoperative nausea and vomiting in scoliosis correction surgery: a double-blind, randomized, placebo-controlled clinical trial. Sci Rep 2019; 9:2119. [PMID: 30765809 PMCID: PMC6376007 DOI: 10.1038/s41598-019-38764-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/07/2019] [Indexed: 11/11/2022] Open
Abstract
Dexamethasone is widely used for postoperative nausea and vomiting (PONV) prophylaxis, but its effect on PONV prevention in paediatric patients is validated only in short minor surgical procedures. In this study, we aimed to determine whether a single dose of dexamethasone reduces PONV in highly invasive surgeries that require opioid-based postoperative analgesia. One hundred adolescents undergoing scoliosis correction surgery were randomized to receive intravenous dexamethasone 0.15 mg/kg (dexamethasone group) or saline (control group) at induction of anaesthesia. The primary outcome was the incidence of PONV in the 72 h postoperatively. Data for 98 patients were available for analysis. The 72-h incidence of PONV was significantly lower in the dexamethasone group than in the control group (62.5% vs 84.0%; RR 0.74, 95% CI 0.58–0.96, P = 0.02). During the first and second 24-h postoperative intervals, fewer patients in the dexamethasone group received rescue antiemetics. Visual analogue scale scores for nausea and pain were lower in the dexamethasone group than in the control group during the first 24 h postoperatively. Dexamethasone did not increase the number of adverse events. The results of this study showed that a single dose of dexamethasone was effective for reducing PONV after paediatric scoliosis correction surgery.
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Frelich M, Divák J, Vodička V, Masárová M, Jor O, Gál R. Dexamethasone Reduces the Incidence of Postoperative Nausea and Vomiting in Children Undergoing Endoscopic Adenoidectomy under General Anesthesia Without Increasing the Risk of Postoperative Hemorrhage. Med Sci Monit 2018; 24:8430-8438. [PMID: 30465722 PMCID: PMC6263352 DOI: 10.12659/msm.911231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Postoperative nausea and vomiting (PONV) is a common complication of pediatric anesthesia, but the overall incidence of PONV in patients undergoing adenoidectomy is unknown. The aim of this controlled study was to compare the effect of dexamethasone administration with placebo to reduce PONV in children undergoing endoscopic adenoidectomy under general anesthesia. Material/Methods A randomized placebo-controlled study included 118 pediatric patients who underwent elective endoscopic adenoidectomy under general anesthesia. A dexamethasone-treated (0.15 mg/kg) group (Group D) (n=56) and a placebo group (Group C) (n=62) were randomly assigned. The incidence of nausea and vomiting was recorded on the day of surgery. Postoperative nausea was assessed according to illustrated Baxter Animated Retching Faces (BARF) scale. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale (scores between 0–10) was used to assess pain. Follow-up was performed on the 14th postoperative day by a telephone call. Results Overall prevalence of postoperative nausea was 25% (30/118) and postoperative vomiting was 14% (17/118). In the first 24 hours following surgery, in Group D, the incidence of nausea and vomiting was 13% and 7%, respectively; in Group C, without pharmacological prophylaxis, the incidence of postoperative nausea and vomiting was 37%, and 21%, respectively. Conclusions A prospective controlled study in children undergoing endoscopic adenoidectomy under general anesthesia showed that dexamethasone (0.15 mg/kg) significantly reduced the incidence of PONV without increasing the risk of postoperative hemorrhage. Dexamethasone is a safe method for the prevention of PONV that may be recommended in pediatric anesthesiology.
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Affiliation(s)
- Michal Frelich
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Jan Divák
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Vojtěch Vodička
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Michaela Masárová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Ondřej Jor
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Roman Gál
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Brno, Brno, Czech Republic
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The use of steroids to reduce complications after tonsillectomy: a systematic review and meta-analysis of randomized controlled studies. Eur Arch Otorhinolaryngol 2018; 276:585-604. [DOI: 10.1007/s00405-018-5202-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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Olson MD, Moore EJ, Price DL. A Randomized Single-Blinded Trial of Posttonsillectomy Liposomal Bupivacaine among Adult Patients. Otolaryngol Head Neck Surg 2018; 159:835-842. [DOI: 10.1177/0194599818791773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine whether liposomal bupivacaine (Exparel) is safe and effective in the management of posttonsillectomy pain among adult patients. Study Design A prospective single-blind randomized controlled trial. Setting An academic quaternary care center (Mayo Clinic, Rochester, Minnesota). Subjects and Methods From May 2015 to December 2016, 39 patients were randomized to receive oral pain medication and 8 mL of injected liposomal bupivacaine or oral pain medication alone for treatment of their posttonsillectomy pain. Visual analog scale pain intensity scores, oral pain medication usage, liquid oral intake, and complications were recorded for 2 weeks after the procedure. Results Thirty-nine patients were randomized, with 17 patients in the liposomal bupivacaine group and 22 in the control group. Fifteen patients in the liposomal bupivacaine group and 18 patients in the control group completed the study. Pain intensity score on postoperative day 1 ( P = .043) proved to be the only statistically significant result, with no difference noted in pain scores on postoperative days 2 to 14. There was no difference in pain medication usage, liquid oral intake, postoperative hemorrhage, or adverse events between groups. Conclusions The injection of liposomal bupivacaine in the posttonsillectomy wound bed demonstrates improved pain intensity scores for the first 24 hours after surgery with no adverse complications noted in comparison with patients who did not receive the injection. Given the limited pain reduction and increased cost, use of liposomal bupivacaine in adult tonsillectomy patients appears to have minimal indication for use.
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Affiliation(s)
- Michael D. Olson
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L. Price
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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Comparison of local and intra venous dexamethasone on post operative pain and recovery after caeseream section. A randomized controlled trial. Taiwan J Obstet Gynecol 2018; 57:346-350. [PMID: 29880162 DOI: 10.1016/j.tjog.2018.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 11/18/2022] Open
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A Narrative Review of the Evidence on the Efficacy of Dexamethasone on Postoperative Analgesic Consumption. Clin J Pain 2018; 33:1037-1046. [PMID: 28177939 DOI: 10.1097/ajp.0000000000000486] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The effect of dexamethasone on analgesic consumption has not been adequately studied. The aim of this review was to investigate recent literature regarding the possible effect of dexamethasone on postoperative analgesic consumption. METHODS Critical review of randomized trials and prospective consecutive studies investigating the postoperative analgesic effect of dexamethasone was performed. Only studies published during 2006 to 2015 were included. RESULTS Forty-one studies met the inclusion criteria; 33 in adults and 8 in children (9 in general surgery, 8 in gynecologic/breast surgery, 8 in orthopedic/spinal surgery, 8 in head/neck surgery, 7 in children's tonsillectomy, and 1 in children's orchiopexy). Literature review demonstrated that dexamethasone can decrease analgesic requirements in patients undergoing laparoscopic cholecystectomies, laparoscopic gynecologic and breast surgery; whereas there is no consensus regarding orthopedic procedures, with positive evidence mostly regarding spinal surgeries. The efficacy of dexamethasone during head and neck surgery is not conclusive; however, its use before thyroid surgery may be beneficial. In children a beneficial impact of dexamethasone administration was revealed on posttonsillectomy reduction of analgesic needs. Studies on other kinds of operations in children are lacking. CONCLUSIONS Dexamethasone administered at a dose of 8 mg before surgical incision may be beneficial in laparoscopic cholecystectomies, thyroid, laparoscopic gynecologic and breast surgery, and tonsillectomies in children. Dexamethasone's potential impact on reducing postoperative analgesic requirements should be investigated in more detail in a systematic manner, to support its use in other kinds of operations.
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Postoperative care after tonsillectomy: what's the evidence? Curr Opin Otolaryngol Head Neck Surg 2017; 25:498-505. [DOI: 10.1097/moo.0000000000000420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Zhu A, Benzon HA, Anderson TA. Evidence for the Efficacy of Systemic Opioid-Sparing Analgesics in Pediatric Surgical Populations. Anesth Analg 2017; 125:1569-1587. [DOI: 10.1213/ane.0000000000002434] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Thung AK, Elmaraghy CA, Barry N, Tumin D, Jatana KR, Rice J, Raman V, Bhalla T, Martin DP, Corridore M, Tobias JD. Double-Blind Randomized Placebo-Controlled Trial of Single-Dose Intravenous Acetaminophen for Pain Associated With Adenotonsillectomy in Pediatric Patients With Sleep-Disordered Breathing. J Pediatr Pharmacol Ther 2017; 22:344-351. [PMID: 29042835 DOI: 10.5863/1551-6776-22.5.344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Adequate pain control is an important component in the postoperative outcome for pediatric adenotonsillectomy patients with sleep-disordered breathing (SDB). Intravenous acetaminophen appears to be a favorable analgesic adjunct owing to its predictable pharmacokinetics and opioid-sparing effects; however, its role in pediatric adenotonsillectomy pain management remains unclear. METHODS In this prospective, randomized, double-blinded, controlled study, subjects with the diagnosis of SDB, aged 2 to 8 years, who required extended postoperative admission, received intravenous acetaminophen (15 mg/kg) or saline placebo intraoperatively in addition to morphine (0.1 mg/kg) for postoperative surgical analgesia. Pain scores in the postanesthesia care unit (PACU) using the FLACC (Faces, Leg, Activity, Cry, Consolability) score were used to determine the need for supplemental analgesic agents in the PACU. The PACU time and time to the first request for pain medication on the inpatient ward were also measured. RESULTS A total of 239 patients were included in the final data analysis (118 in the intravenous acetaminophen group and 121 in the saline placebo group). The 2 groups did not differ in the proportion of patients reaching FLACC scores = 4 in the PACU (p = 0.223); mean FLACC scores in the PACU (p = 0.336); mean PACU time (p = 0.883); or time to requesting pain medication on the inpatient ward (p = 0.640). CONCLUSIONS A single intraoperative dose of intravenous acetaminophen did not alter the postoperative course of pediatric patients with SDB following adenotonsillectomy.
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Affiliation(s)
- Arlyne K Thung
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - Charles A Elmaraghy
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - N'Diris Barry
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - Kris R Jatana
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Rice
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - Vidya Raman
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - David P Martin
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - Marco Corridore
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine (AKT, N'DB, DT, JR, VR, TB, DPM, MC, JDT), Department of Otolaryngology (CAE, KRJ), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology and Pain Medicine (AKT, DT, VR, TB, DPM, JDT), Department of Otolaryngology (CAE KRJ), The Ohio State University College of Medicine, Columbus, Ohio
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Topal K, Aktan B, Sakat MS, Kilic K, Gozeler MS. Post-operative pain control after tonsillectomy: dexametasone vs tramadol. Acta Otolaryngol 2017; 137:618-622. [PMID: 28084857 DOI: 10.1080/00016489.2016.1269945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION Tramadol was found to be more effective than dexamethasone in post-operative pain control, with long-lasting relief of pain. OBJECTIVE This study aimed to compare the effects of pre-operative local injections of tramadol and dexamethasone on post-operative pain, nausea and vomiting in patients who underwent tonsillectomy. DESIGN Sixty patients between 3-13 years of age who were planned for tonsillectomy were included in the study. Patients were divided into three groups. Group 1 was the control group. Patients in Group 2 received 0.3 mg/kg Dexamethasone and Group 3 received 0.1 mg/kg Tramadol injection to the peritonsillary space just before the operation. Patients were evaluated for nausea, vomiting, and pain. RESULTS When the control and the dexamethasone groups were compared; there were statistically significant differences in pain scores at post-operative 15 and 30 min, whereas there was no statistically significant difference in pain scores at other hours. When the control and tramadol groups were compared, there was a statistically significant difference in pain scores at all intervals. When tramadol and dexamethasone groups were compared, there was no statistically significant difference in pain scores at post-operative 15 and 30 min, 1 and 2 h, whereas there was a statistically significant difference in pain scores at post-operative 6 and 24 h.
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Affiliation(s)
- Kubra Topal
- Department of Otorhinolaryngology, Training and Research Hospital, Erzurum, Turkey
| | - Bulent Aktan
- Faculty of Medicine, Department of Otorhinolaryngology, Ataturk University, Erzurum, Turkey
| | - Muhammed Sedat Sakat
- Faculty of Medicine, Department of Otorhinolaryngology, Ataturk University, Erzurum, Turkey
| | - Korhan Kilic
- Department of Otorhinolaryngology, Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Sitki Gozeler
- Faculty of Medicine, Department of Otorhinolaryngology, Ataturk University, Erzurum, Turkey
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Flubacher P, Fournier N, Cherpillod J, Waridel F, Nydegger M, Albrecht E. A randomised controlled trial of placebo, droperidol or ondansetron to prevent nausea and vomiting after tonsillectomy in children receiving dexamethasone. Anaesthesia 2017; 72:859-863. [DOI: 10.1111/anae.13907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- P. Flubacher
- Department of Anaesthesia; Lausanne University Hospital; Lausanne Switzerland
| | - N. Fournier
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital; Lausanne Switzerland
| | - J. Cherpillod
- Department of Otolaryngology - Head and Neck Surgery; Lausanne University Hospital; Lausanne Switzerland
| | - F. Waridel
- Department of Otolaryngology - Head and Neck Surgery; Lausanne University Hospital; Lausanne Switzerland
| | - M. Nydegger
- Department of Anaesthesia; Lausanne University Hospital; Lausanne Switzerland
| | - E. Albrecht
- Department of Anaesthesia; Lausanne University Hospital; Lausanne Switzerland
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Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg 2017; 156:442-455. [PMID: 28094660 PMCID: PMC5639328 DOI: 10.1177/0194599816683915] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/22/2016] [Indexed: 01/21/2023]
Abstract
Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.
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Affiliation(s)
- David O. Francis
- Department of Otolaryngology, Vanderbilt University Medical Center
| | - Chris Fonnesbeck
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Nila Sathe
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Melissa McPheeters
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Siva Chinnadurai
- Department of Otolaryngology, Vanderbilt University Medical Center
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Xie M, Li XK, Peng Y. Magnesium sulfate for postoperative complications in children undergoing tonsillectomies: a systematic review and meta-analysis. J Evid Based Med 2017; 10:16-25. [PMID: 27787936 DOI: 10.1111/jebm.12230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/01/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Previous systematical reviews showed that systemic magnesium decreased postoperative pain and reduced morphine use without any reported serious adverse effects in adults. However, studies in children yielded different results. So we conducted a systematic review to evaluate the impact of magnesium sulfate on postoperative complications in children undergoing tonsillectomies. METHODS The PubMed, EMbase via OVID, CENTRAL, and WHO ICTRP were searched to identify randomized controlled trials that addressed the effect of magnesium for postoperative pain, agitation, and complications in children undergoing tonsillectomies. Two reviewers screened titles and abstracts for eligibility and assessed the quality of the included studies. The meta-analysis was performed using RevMan 5.3. RESULTS Ten randomized controlled trials involving 665 participates published between 2003 and 2015 were included. Eight studies showed no different effect on pain scores between MgSO4 and control groups. Two studies showed significant lower emergence agitation incidence in MgSO4 group (pooled OR = 0.18, 95% CI 0.07 to 0.48, P = 0.0006). Five studies showed rescue analgesia was reduced in MgSO4 group (RR = 0.53, 95% CI 0.31 to 0.91, P = 0.02). Laryngospasm was founded lower in MgSO4 group (OR = 0.36, 95% CI 0.13 to 0.96, P = 0.04). Postoperative nausea and vomiting was found no difference between two groups (OR = 1.23, 95% CI 0.70 to 2.18, P = 0.47). CONCLUSION Unlike the studies in adults, this review shows there is no statistically significant effect of perioperative use of magnesium in the postoperative pain control in children undergoing tonsillectomies. But it seems has benefits in reducing rescue analgesia, emergence agitation incidence, and laryngospasm.
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Affiliation(s)
- Min Xie
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiang-Kui Li
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Yu Peng
- Department of Editorial, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
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Naja Z, Kanawati S, Al Khatib R, Ziade F, Naja ZZ, Naja AS, Rajab M. The effect of IV dexamethasone versus local anesthetic infiltration technique in postoperative nausea and vomiting after tonsillectomy in children: A randomized double-blind clinical trial. Int J Pediatr Otorhinolaryngol 2017; 92:21-26. [PMID: 28012528 DOI: 10.1016/j.ijporl.2016.10.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/10/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Local anesthetic infiltration and corticosteroids had shown effectiveness in reducing post tonsillectomy nausea, vomiting and pain. OBJECTIVES To compare the effect of intravenous dexamethasone versus pre-incision infiltration of local anesthesia in pediatric tonsillectomy on postoperative nausea and vomiting (PONV). The secondary objective was postoperative pain. METHODS A randomized double-blind clinical trial was conducted at a tertiary care teaching hospital. Children admitted to undergo tonsillectomy aged between 4 and 13 years from January 2015 to August 2015 were enrolled and divided into two groups. Both groups had general anesthesia. Group I received intravenous dexamethasone 0.5 mg/kg (maximum dose 16 mg) with placebo pre-incision infiltration. Group II received pre-incision infiltration a total of 2-4 ml local anesthesia mixture with saline and an equivalent volume of intravenous saline. RESULTS Group I consisted of 64 patients while group II had 65 patients. In the PACU, 15.6% of patients in group I experienced vomiting compared to 3.1% in group II (p-value = 0.032). After 24 h, the incidence of PONV was significantly higher in group I compared to group II (26.6% vs. 9.2% respectively, p-value = 0.019). At 48 h postoperatively, PONV was significantly higher in group I (p-value = 0.013). The incidence was similar in both groups after three, four and five postoperative days. Baseline pain and pain during swallowing were significantly different at 6, 12 and 24 h as well as days 1 through 5. Pain upon jaw opening was significantly different at 6, 12 and 24 h between the two groups. Pain while eating soft food was significantly different at 24 h and days 2 through 5. In the PACU, 20.3% of patients in group I received diclofenac compared to 3.1% in group II (p-value = 0.005). From day 1 till day 5, analgesic consumption was significantly higher in group I. CONCLUSION Local anesthetic infiltration in addition to NSAIDS and paracetamol could serve as a multimodal analgesia and decrease PONV. TRIAL REGISTRATION NCT02355678.
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Affiliation(s)
- Zoher Naja
- Anesthesia and Pain Management Department, Makassed General Hospital, Beirut, Lebanon.
| | - Saleh Kanawati
- Anesthesia and Pain Management Department, Makassed General Hospital, Beirut, Lebanon
| | - Rania Al Khatib
- Anesthesia and Pain Management Department, Makassed General Hospital, Beirut, Lebanon
| | - Fouad Ziade
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Zeina Z Naja
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Salah Naja
- Medicine Department, Lebanese American University, Beirut, Lebanon
| | - Mariam Rajab
- Pediatrics Department, Makassed General Hospital, Beirut, Lebanon
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Roberts CA, Shah-Becker S, Derr JB, Sedeek K, Carr MM. Effect of single dose intraoperative IV acetaminophen in pediatric tonsillectomy or adenotonsillectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Christopher A. Roberts
- The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Shivani Shah-Becker
- The Pennsylvania State University, College of Medicine, Department of Surgery, 500 University Drive, Hershey, PA, USA
| | - Jonathan B. Derr
- The Pennsylvania State University, College of Medicine, Department of Surgery, 500 University Drive, Hershey, PA, USA
| | - Khaled Sedeek
- The Pennsylvania State University, College of Medicine, Department of Anesthiology, 500 University Drive, Hershey, PA, USA
| | - Michele M. Carr
- The Pennsylvania State University, College of Medicine, Department of Surgery, 500 University Drive, Hershey, PA, USA
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Wilson CA, Sommerfield D, Drake-Brockman TFE, von Bieberstein L, Ramgolam A, von Ungern-Sternberg BS. Pain after discharge following head and neck surgery in children. Paediatr Anaesth 2016; 26:992-1001. [PMID: 27397757 DOI: 10.1111/pan.12974] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is well established that children experience significant pain for a considerable period following adenotonsillectomy. Less is known, however, about pain following other common head and neck operations. AIM The aim of this study was to describe the severity and duration of postoperative pain experienced by children undergoing elective head and neck procedures (primary outcomes). Behavioral disturbance, nausea and vomiting, parental satisfaction, and medical reattendance rates were also measured (secondary outcomes). METHOD Parents of children (0-18 years) undergoing common head and neck operations were invited to participate. Pain scores on the day of surgery and each day post discharge were collected via multiple telephone interviews. Data collected included pain levels, analgesia prescribed and given, behavioral disturbance rates, and nausea and vomiting scores. Follow-up was continued until pain resolved. RESULTS Two hundred and fifty-one patients were analyzed (50 adenoidectomy, 51 adenotonsillectomy, 19 myringoplasty, 52 myringotomy, 43 strabismus, and 36 tongue tie divisions). On the day of surgery myringoplasty, strabismus surgery, and adenotonsillectomy patients on average had moderate pain, whereas adenoidectomy, tongue tie, and myringotomy patients had mild pain. Adenotonsillectomy patients continued to have moderate pain for several days with pain lasting on average 9 days. From day 1 postoperatively mild pain was experienced in the other surgical groups with the average duration of pain varying from 1 to 3 days depending on the surgery performed. Frequency of behavioral issues closely followed pain scores for each group. Analgesic prescribing and regimes at home varied widely, both within and between the different surgical groups. Rates of nausea and vomiting following discharge were low in all groups. The overall unplanned medical reattendance rate was 16%. CONCLUSION Adenotonsillectomy patients represent the biggest challenge in postoperative pain management of the head and neck surgeries evaluated. The low rates of pain, nausea, and vomiting reported in the days following surgery for the other procedures suggests that children can be cared for at home with simple analgesia. Discharge information and analgesia prescribing on discharge should be tailored to the operation performed.
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Affiliation(s)
- Caroline A Wilson
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Thomas F E Drake-Brockman
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
| | - Lita von Bieberstein
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Anoop Ramgolam
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
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Moeen SM. Could acupuncture be an adequate alternative to dexamethasone in pediatric tonsillectomy? Paediatr Anaesth 2016; 26:807-14. [PMID: 27328737 DOI: 10.1111/pan.12933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Usage of nonpharmacological treatment contributes to an overall patient well-being, assisting in physical and emotional healing. Acupuncture has been reported to be useful in reducing early postoperative vomiting (POV) and attenuating postoperative pain. AIM The aim of this study was to compare the effect of dexamethasone vs acupuncture at P6 bilaterally and CV13 on the incidence and severity of POV in children undergoing tonsillectomy with or without adenoidectomy. METHOD One hundred and twenty children, ASA I-III aged 2-8 years undergoing elective tonsillectomy were included in this prospective randomized double-blind study. Children were randomly divided into two equal groups (60 each). At induction of anesthesia, the dexamethasone group received 0.15 mg·kg(-1) dexamethasone IV plus sham acupuncture, and the acupuncture group received acupuncture at P6 bilaterally and CV13 plus 2 ml of normal saline IV. Vomiting was recorded at 0-6, 6-24, and 0-24 h postoperatively. RESULTS There was no difference in the incidence of vomiting between the acupuncture and dexamethasone groups. The mean difference in time to first oral intake (95% CI) was 4.3 (0.5-8.6) min between dexamethasone group and acupuncture group; P = 0.426. The mean difference in time until first vomit (95% CI) was 12 (9.5-13.8) min between both groups. No significant differences between Kaplan-Meier curves for time until first vomit (log-rank test) were obtained (P = 0.697). CONCLUSION Acupuncture at P6 bilaterally and CV13 provided similar antiemetic effect to dexamethasone in children undergoing tonsillectomy.
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Affiliation(s)
- Seham M Moeen
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Asyut, Egypt
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Conlon JA, Matthews A, O'Mathúna DP. Analgesics for postoperative pain after tonsillectomy and adenoidectomy in children. Hippokratia 2016. [DOI: 10.1002/14651858.cd011638.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Joy A Conlon
- Dublin City University; School of Nursing and Human Sciences; Dublin Ireland 9
| | - Anne Matthews
- Dublin City University; School of Nursing and Human Sciences; Dublin Ireland 9
| | - Dónal P O'Mathúna
- Dublin City University; School of Nursing and Human Sciences; Dublin Ireland 9
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Benzon HA, Shah RD, Hansen J, Hajduk J, Billings KR, De Oliveira GS, Suresh S. The Effect of Systemic Magnesium on Postsurgical Pain in Children Undergoing Tonsillectomies: A Double-Blinded, Randomized, Placebo-Controlled Trial. Anesth Analg 2016; 121:1627-31. [PMID: 26501831 DOI: 10.1213/ane.0000000000001028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Tonsillectomy is a frequently performed surgical procedure in children; however, few multimodal analgesic strategies have been shown to improve postsurgical pain in this patient population. Systemic magnesium infusions have been shown to reliably improve postoperative pain in adults, but their effects in pediatric surgical patients remain to be determined. In the current investigation, our main objective was to evaluate the use of systemic magnesium to improve postoperative pain in pediatric patients undergoing tonsillectomy. We hypothesized that children who received systemic magnesium infusions would have less post-tonsillectomy pain than the children who received saline infusions. METHODS The study was a prospective, randomized, double-blinded, clinical trial. Subjects were randomly assigned using a computer-generated table of random numbers to 1 of the 2 intervention groups: systemic magnesium infusion (initial loading dose 30 mg/kg given over 15 minutes followed by a continuous magnesium infusion 10 mg/kg/h) and the same volume of saline. The primary outcome was pain scores in the postanesthesia care unit (PACU) measured by FLACC (Face, Legs, Activity, Cry, Consolability) pain scores. Pain reduction was measured by the decrement in the area under the pain scale versus 90-minute postoperative time curve using the trapezoidal method. Secondary outcomes included opioid consumption in the PACU, emergence delirium scores (measured by the pediatric anesthesia emergence delirium scale), and parent satisfaction. RESULTS Sixty subjects were randomly assigned and 60 completed the study. The area under pain scores (up to 90 minutes) was not different between the study groups, median (interquartile range [IQR]) of 30 (0-120) score × min and 45 (0-135) score × min for the magnesium and control groups, respectively (P = 0.74). Similarly, there was no clinically significant difference in the morphine consumption in the PACU between the magnesium group, median (IQR) of 2.0 (0-4.44) mg IV morphine, compared with the control, median (IQR) of 2.5 (0-4.99) mg IV morphine (P = 0.25). The serum level of magnesium was significantly lower in the control group than in the treatment group at the end of the surgery (P < 0.001). CONCLUSIONS Despite a large number of studies demonstrating the efficacy of systemic magnesium for preventing postsurgical pain in adults, we could not find evidence for a significant clinical benefit of systemic magnesium infusion in children undergoing tonsillectomies. Our findings reiterate the importance of validating multimodal analgesic strategies in children that have been demonstrated to be effective in the adult population.
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Affiliation(s)
- Hubert A Benzon
- From the *Department of Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois; and †Department of Anesthesiology, Northwestern University, Chicago, Illinois
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Ji L, Zhang X, Fan H, Han M, Yang H, Tang L, Shao Y, Lan Y, Li D. drawMD APP-aided preoperative anesthesia education reduce parents anxiety and improve satisfaction. PATIENT EDUCATION AND COUNSELING 2016; 99:265-270. [PMID: 26372077 DOI: 10.1016/j.pec.2015.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/27/2015] [Accepted: 08/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE There is no existing standard format for preoperative anesthesia education. The drawMD APP is an visible preoperative education tool. The aim of this study was to evaluate the effects of drawMD APP on pre-operative anesthesia education. METHODS The parents were randomized to receive drawMD APP-aided pre-operative anesthesia education or standard verbal education. Parental anxiety was measured before education (T0) and immediately after education (T1), and after operation (T4). Children's anxiety was assessed before education (T0) and at the operation room (T2). Children's emergence behavior and Parents' satisfaction were assessed after operation (T4). RESULTS The parents' anxiety levels at T1 and T4 were significantly lower than that of the control. The satisfaction scores in the drawMD group were significantly higher than that in the control group. There were no differences in children's anxiety and the incidence of emergence delirium between the two groups. CONCLUSIONS The drawMD APP-aided pre-operative education is effective in the reduction of parental pre-operative anxiety and in improvement of parents' satisfaction, but has no influence on children. PRACTICE IMPLICATIONS Anesthesiologists can consider using drawMD APP to conduct pre-operative education in parents whose children are scheduled for surgery.
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Affiliation(s)
- Liting Ji
- Department of Anesthesiology, Second Hospital of Dalian Medical University, Dalian, Liaoninng, China
| | - Xiaoping Zhang
- Department of Anesthesiology, Second Hospital of Dalian Medical University, Dalian, Liaoninng, China
| | - Hui Fan
- Department of Oncology, Second Hospital of Dalian Medical University, Dalian, Liaoninng, China
| | - Mei Han
- Department of Anesthesiology, Second Hospital of Dalian Medical University, Dalian, Liaoninng, China
| | - Haitao Yang
- Department of Anesthesiology, Second Hospital of Dalian Medical University, Dalian, Liaoninng, China
| | - Lihua Tang
- Department of Anesthesiology, Second Hospital of Dalian Medical University, Dalian, Liaoninng, China
| | - Yan Shao
- Department of Operating Room, Second Hospital of Dalian Medical University, Dalian, Liaoninng, China
| | - Yunping Lan
- Department of Anesthesiology, City Center Hospital of Qu Zhou, Qu Zhou, Zhejiang, China
| | - Dongbai Li
- Department of Anesthesiology, Second Hospital of Dalian Medical University, Dalian, Liaoninng, China.
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Abstract
Pediatric post-tonsillectomy analgesia continues to be highly debated and an area of active research. Tonsillectomy pain can lead to significant patient morbidity, and incur potentially avoidable healthcare costs. Moreover, the various analgesic classes, each present their own risk profiles and unique side effects when used in children post-tonsillectomy. This review delineates the clinical and pathophysiological basis for post-tonsillectomy pain, types of analgesics and their risk profiles, as well as special considerations in this clinical population and a review of alternative analgesic treatment options. This article presents a summary of recent literature and discusses evidence-based management options to aid medical and allied health professionals who may encounter these patients.
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Affiliation(s)
- Natasha Cohen
- Otolaryngology, Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Doron D Sommer
- Otolaryngology, Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
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Shirazi M, Mahmoudi H, Nasihatkon B, Ghaffaripour S, Eslahi A. Efficacy of dexamethasone on postoperative analgesia in children undergoing hypospadias repair. Pak J Med Sci 2016; 32:125-9. [PMID: 27022359 PMCID: PMC4795851 DOI: 10.12669/pjms.321.9089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/15/2015] [Accepted: 12/02/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Management of post operative pain in children undergoing hypospadiasis repair, accounts for optimized surgery outcomes and improved patients' satisfaction. Thus, various studies have widely investigated the best approaches for the pain management. In this study our aim was to determine the effect of dexamethasone in combination with penile nerve block on the postoperative pain and complications in the children undergoing hypospadias surgery. METHODS In this randomized double-blind placebo controlled trial, after obtaining informed consent from parents or legal guardians, 42 children undergoing surgical treatment of hypospadias were randomized in two groups to receive either IV dexamethasone 0.5 mg/kg (n=23) or placebo (normal saline) (n=19) during the operation. Penile block was performed in both groups using Bupivacaine 0.5% (1mg/kg) at the end of the procedure. By the end of the operation, FLACC (Face, Leg, Activity, Cry, Consolability) pain score was assessed as the primary outcome of the study. Secondary outcomes includes timing and episodes of rescue medication consumption, post operative nausea \vomiting and bleeding. All the outcomes were assessed in the recovery room and after 2, 6, 12, and 24 hours. RESULTS The median of FLACC pain scores at the recovery room and 2, 6, 12, and 24 hours post operation was 2, 1, 1, 1, and 2 for the dexamethasone group and 8, 8, 7, 7, and 8 for the placebo group respectively. This were significantly different (P<0.000). The median time of first rescue medication consumption was 8 hours post operation for the dexamethasone group and three hours for the placebo group which was significantly different (z= 4.57, p<0.000). The maximum episode of post operative rescue medication consumption in dexamethasone group was 4 episodes in only one patient and the minimum was one episode in 11 patients. In comparison numbers in placebo group were five episodes in seven patients and three episodes in four patients. The result indicated that there was statistically significant difference between two groups in terms of episodes of rescue medication consumption (Chi2= 31.4, p<0.000). CONCLUSION Single dose of intravenous dexamethasone (0.5 mg/kg) in combination with penile block decreased the post operative pain measures, and total post operative analgesic requirement. It also increased the onset of the first analgesic requirement compared to penile block alone.
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Affiliation(s)
- Mehdi Shirazi
- Dr. Mehdi Shirazi, Associate Professor of Urology, Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hilda Mahmoudi
- Dr. Hilda Mahmoudi, Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Nasihatkon
- Dr. Behnam Nasihatkon, Urologist, Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Ghaffaripour
- Dr. Sina Ghaffaripour, Associate Professor of Anesthesiology, Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Eslahi
- Dr. Ali Eslahi, Assistant Professor of Urology, Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
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Aveline C, Le Hetet H, Le Roux A, Bonnet F. A survey of the administration of prednisolone versus ibuprofen analgesic protocols after ambulatory tonsillectomy. Anaesth Crit Care Pain Med 2015; 34:281-7. [DOI: 10.1016/j.accpm.2014.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/10/2014] [Indexed: 10/22/2022]
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Gao W, Zhang QR, Jiang L, Geng JY. Comparison of local and intravenous dexamethasone for postoperative pain and recovery after tonsillectomy. Otolaryngol Head Neck Surg 2015; 152:530-5. [PMID: 25605698 DOI: 10.1177/0194599814567856] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare local infiltration of dexamethasone to intravenous injection for postoperative pain and recovery after tonsillectomy. STUDY DESIGN Prospective, randomized study. SETTING Second Affiliated Hospital of Harbin Medical University. SUBJECTS AND METHODS Children (n=240, American Society of Anesthesiologists [ASA] classes I-II, aged 5-10 y) scheduled for tonsillectomy were randomly and equally assigned to 3 groups: DEX-IV, for intravenous injection of dexamethasone (0.5 mg/kg, maximum dose 24 mg); DEX-INF, given the same amount of dexamethasone by local infiltration to the upper middle and lower poles of the tonsils; and a control group not given dexamethasone. Postoperative pain was scored at intervals from 30 minutes to 24 hours. The time to first administration of analgesic and average consumption of analgesic, times to first oral water and solid food intake, and incidence rates of nausea and vomiting were evaluated. RESULTS From postoperative 1 to 16 hours, the DEX-INF group had significantly lower pain scores than did the DEX-IV group, and the time to first analgesic and average consumption of analgesic were also significantly lower. The times to first oral water and food intake in the DEX-INF group were significantly shorter than in the DEX-IV group. The incidence of nausea and vomiting in the DEX-INF group was higher than that of the DEX-IV group. CONCLUSION Local infiltration of dexamethasone was more effective than systemic administration to decrease pain and time to food intake, but the antiemetic effect was less. CLINICAL TRIALS REGISTRATION NUMBER ChiCTR-TRC-13003535.
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Affiliation(s)
- Wei Gao
- Department of Anesthesiology, Second Affiliated Hospital, Harbin Medical University, Nangang District of Harbin, Harbin, China
| | - Qin Rui Zhang
- Department of Anesthesiology, Second Affiliated Hospital, Harbin Medical University, Nangang District of Harbin, Harbin, China
| | - Lei Jiang
- Department of Anesthesiology, Second Affiliated Hospital, Harbin Medical University, Nangang District of Harbin, Harbin, China
| | - Jie Ying Geng
- Department of Anesthesiology, Second Affiliated Hospital, Harbin Medical University, Nangang District of Harbin, Harbin, China
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Perioperative Dexamethasone and the Development of Chronic Postmastectomy Pain. Reg Anesth Pain Med 2015; 40:539-44. [DOI: 10.1097/aap.0000000000000301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
PURPOSE OF REVIEW Postoperative nausea and vomiting (PONV) has a high incidence in children and requires prophylactic and therapeutic strategies. RECENT FINDINGS PONV can be reduced by the avoidance of nitrous oxide, volatile anesthetics, and the reduction of postoperative opioids. The use of dexamethasone, 5-HT3 antagonists, or droperidol alone is potent, but combinations are even more effective to reduce PONV. Droperidol has a Food and Drug Administration warning. Hence, dexamethasone and 5-HT3 antagonists should be preferred as prophylactic drugs. It is further reasonable to adapt PONV prophylaxis to different risk levels. Prolonged surgery time, inpatients, types of surgery (e.g. strabismus and ear-nose-throat surgery), and patients with PONV in history should be treated as high risk, whereas short procedures and outpatients are to be treated as low risk. SUMMARY Concluding from the existing guidelines and data on the handling of PONV in children at least 3 years, the following recommendations are given: outpatients undergoing small procedures should receive a single prophylaxis, outpatients at high risk a double prophylaxis, inpatients with surgery time of more than 30 min and use of postoperative opioids should get double prophylaxis, and inpatients receiving a high-risk surgical procedure or with other risk factors a triple prophylaxis (two drugs and total intravenous anesthesia). Dimenhydrinate can be used as a second choice, whereas droperidol and metoclopramide can only be recommended as rescue therapy.
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Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a meta-analysis of randomized controlled trials. PAIN RESEARCH AND TREATMENT 2014; 2014:179029. [PMID: 25485150 PMCID: PMC4251083 DOI: 10.1155/2014/179029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/09/2014] [Indexed: 12/13/2022]
Abstract
Background. The overall effect of perineural dexamethasone on postoperative analgesia outcomes has yet to be quantified. The main objective of this quantitative review was to evaluate the effect of perineural dexamethasone as a nerve block adjunct on postoperative analgesia outcomes. Methods. A systematic search was performed to identify randomized controlled trials that evaluated the effects of perineural dexamethasone as a block adjunct on postoperative pain outcomes in patients receiving regional anesthesia. Meta-analysis was performed using a random-effect model. Results. Nine randomized trials with 760 subjects were included. The weighted mean difference (99% CI) of the combined effects favored perineural dexamethasone over control for analgesia duration, 473 (264 to 682) minutes, and motor block duration, 500 (154 to 846) minutes. Postoperative opioid consumption was also reduced in the perineural dexamethasone group compared to control, -8.5 (-12.3 to -4.6) mg of IV morphine equivalents. No significant neurological symptoms could have been attributed to the use of perineural dexamethasone. Conclusions. Perineural dexamethasone improves postoperative pain outcomes when given as an adjunct to brachial plexus blocks. There were no reports of persistent nerve injury attributed to perineural administration of the drug.
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