舌咽神经阻滞对儿童扁桃体切除术后疼痛的影响

目的探讨布比卡因舌咽神经阻滞对儿童扁桃体切除术后疼痛的影响。方法采用前瞻性随机对照研究方法，收集92例行扁桃体手术切除的患儿，随机分为布比卡因舌咽神经阻滞组（治疗组）和未接受布比卡因舌咽神经阻滞组（对照组）各46例，其中，治疗组在手术结束后立即行布比卡因双侧舌咽神经阻滞，对照组手术结束后不给予任何处理，比较两组术后首次请求镇痛的时间、使用对乙酰氨基酚镇痛平均剂量，术后休息和吞咽时对患儿面部表情（face）、腿的姿势(legs)、躯体活动度(activity)、哭闹(crying)、是否安慰(consolability)5项进行疼痛评分（FLACC），术后咽反射情况、吞咽困难程度，以及术后并发症发生率和父母满意度。结果治疗组术后首次请求对乙酰氨基酚镇痛的时间较对照组明显延长（P<0.01），使用对乙酰氨基酚的平均剂量明显低于对照组（P<0.05）；治疗组在术后6 h休息和吞咽时FLACC评分较对照组明显降低（P<0.01）；治疗组对咽反射的反应和吞咽困难程度较对照组明显降低（P＜0.01）；而术后并发症的发生率没有增加（P>0.05），父母的满意度较对照组有明显提高（P＜0.01）。结论布比卡因双侧舌咽神经阻滞可有效地减轻儿童扁桃体切除术后早期疼痛，改善患儿术后生理舒适度及生活质量，提高父母满意度，而无明显麻醉不良反应。     

扁桃体术后疼痛相关因素分析

目的:探讨影响扁桃体术后疼痛的相关因素。方法:收集90例扁桃体切除术的患者,建立数据库,采用χ2检验进行统计学分析。结果:统计结果分析提示,性别、年龄、手术方式、手术例数、超前镇痛、物理镇痛、术前焦虑水平是影响术后疼痛的主要因素。结论:扁桃体术后疼痛除手术本身影响因素外,还受到如超前镇痛、术前焦虑水平等多种因素的影响。     

地塞米松在成人扁桃体切除术后镇痛中的应用研究

目的 研究地塞米松在成人扁桃体切除术后镇痛中的应用效果。方法 选取行双侧扁桃体切除术的成人患者97例为研究对象,随机分为实验组（应用地塞米松）和对照组（不应用地塞米松组）。记录患者自手术当天至术后第6天的每日局部疼痛情况并进行评分。结果 在手术当天至术后4天,实验组的术后局部疼痛程度比对照组有较明显的减轻,差异有统计学意义;但在术后第5、6天,两组差异无统计学意义。结论 成人扁桃体切除术后应用地塞米松,可以较好地减轻手术当天至术后第4天的疼痛。     

用丁哌卡因局部浸润减轻全麻扁桃体增殖体切除术患儿的术后疼痛

扁桃体和腺样体切除仍为常见手术,术后有不同程度疼痛,但与手术和麻醉(全麻或局麻)无明显关系。实验结果提示:甚至全麻下手术时,由外周神经向中枢神经系统传入的疼痛冲动仍可引发生理变化,导致神经过度兴奋状态的形成,使术后疼痛时间延长,术中加局麻可阻断上述过程而使术后疼痛减轻。     

芬太尼透皮贴剂用于扁桃体术后镇痛

扁桃体摘除术后疼痛是一种典型而严重的术后疼痛,但至今仍无很好镇痛方法。我科自2001年6月—2004年2月使用芬太尼透皮贴剂(多瑞吉)对成人扁桃体术后疼痛止痛效果临床观察,取得较好疗效。一、材料与方法本组共40例病例,全部病例均符合慢性扁桃体炎的诊断标准、手术适应证。其中男32例,女8例。年龄18~41岁,平均年龄27岁。以抽签法随机分为2组,治疗组20例,对照组20例。两组患者在性别年龄及全身情况无明显差别,均于上午在局部麻醉下行双侧扁桃体摘除术。手术方法和麻醉方法(利多卡因+肾上腺素)完全相同。术后每例患者一律连续3d给抗生素输…     

扁桃体切除术后止痛

扁桃体切除术后止痛尚无良策。Weligodpola(1983)宣称挤切法比剥离法疼痛轻,但许多医院未将挤切法列为常规手术。Aastrop等(1976)采用冷冻手术,疼痛未见明显减轻。Ritter等认为电凝较结扎止血术后疼痛轻;Roy等(1976)则报告电凝止血术后疼痛增剧。Penn(1952)报告局部应用激素、局麻及抗生素可减轻术后疼痛;但Davison(1952)、Anderson等(1975)认为局部注射无效,反可增加     

扁桃体切除术后舌下神经麻痹

扁桃体切除术是耳鼻咽喉科医生最常做的手术之一,而扁桃体切除术后的外周神经损伤在耳鼻咽喉科文献中却罕见报道。舌咽神经和舌神经紧邻扁桃体床走行,因而可能易于受直接或间接损伤,如插管困难导致神经受到牵拉和压迫而表现舌神经麻痹。舌下神经     

氟比洛芬酯静注联合罗哌卡因棉球填塞扁桃体窝对扁桃体切除术患儿的镇痛效果分析

目的　探讨氟比洛芬酯静注联合罗哌卡因棉球填塞扁桃体窝局部浸润在缓解扁桃体切除患儿术后疼痛方面的应用价值。方法 将83例全麻双侧扁桃体切除术患儿按照随机数字表法分为三组，其中单用1组28例、单用2组27例和联用组28例。三组患儿在麻醉诱导后分别采用氟比洛芬酯镇痛、罗哌卡因棉球镇痛和两者联合使用镇痛。评估三组患儿术后的视觉模拟量表（visual analogue scale，VAS）和麻醉苏醒期躁动量表（pediatric anesthesia emergence delirium，PEAD）评分，记录患儿追加镇痛药物情况以及术后不良反应的发生情况。结果　单用1组和单用2组患儿在苏醒后不同时间点的VAS评分明显高于联用组患儿（P 均<0.05）；在拔管时及拔管后PAED评分均明显高于联用组患儿（P 均<0.05）；术后芬太尼使用比例明显高于联用组（P 均<0.05）。结论　氟比洛芬酯静注联合罗哌卡因棉球填塞扁桃体窝局部浸润在缓解扁桃体切除患儿术后疼痛和苏醒期躁动方面更具优势。     

扁桃体手术的演变和进展

扁桃体切除术是耳鼻咽喉科常见的手术之一,其手术时间、术中出血量和术后疼痛等并发症是影响手术质量和患者术后恢复的重要因素。为寻求一种更安全、有效的手术方式,电刀、等离子、激光、超声刀等新器械和技术被应用于扁桃体切除。为此,本文针对扁桃体切除的主要手术方式原理、操作方法、优缺点、临床应用和扁桃体手术的演变进程做一综述,为临床扁桃体切除提供较为合理的参考。     

低温等离子刀扁桃体切除术与传统扁桃体剥离术疗效的比较

目的:比较分析低温等离子刀扁桃体切除术与传统扁桃体剥离术的疗效。方法:将64例慢性扁桃体炎患者随机分为传统扁桃体剥离术(传统手术组)和低温等离子刀扁桃体切除术(等离子手术组)2组。传统手术组39例采用传统扁桃体剥离术治疗,等离子手术组25例采用低温等离子刀扁桃体切除术治疗。分析2组手术方式在手术时间、术中出血量、术后疼痛时间、术后出血发生概率上有无差异。结果:传统手术组与等离子手术组在手术时间、术中出血量、术后疼痛时间上差异有统计学意义(P<0.05);2组术后出血发生概率差异无统计学意义(P>0.05)。结论:低温等离子刀扁桃体切除术较传统扁桃体剥离术手术时间短,术中出血少,术后疼痛轻,恢复快,安全性高。     

Preoperative intravenous dexamethasone combined with glossopharyngeal nerve block: role in pediatric postoperative analgesia following tonsillectomy

Tonsillectomy is one of the most frequently performed ambulatory surgical procedures in children (Litman et al. in Anesth Analg 78:478–481, 1994). Several techniques have been described for alleviation of pain (Ginstrom et al. in Acta Otolaryngol 125:972–975, 2005). the objective of this study determination of the postoperative analgesic efficacy of the pre-surgical intravenous administration of dexamethasone together with glossopharyngeal nerve block (GNB) in children undergoing tonsillectomy. Prospective double blind randomized control study using both pre-operative injection of 0.5 mg/kg dexamethasone iv and 3 ml of 0.5% bupivacaine local injection for bilateral glossopharyngeal nerve block. Patients in group B had significantly less visual analogue scale values, longer absolute analgesia time, lesser swallowing difficulty and they were discharged earlier from the hospital when compared to patients in both groups D and G. Using both pre-operative dexamethasone IV injection with GNB has reduced postoperative pain and morbidity to a great extent than using either alone.     

Tonsillectomy or tonsillotomy?--A randomized study comparing postoperative pain and long-term effects

BACKGROUND: tonsillectomy (TE) is currently the most common treatment for children with snoring and sleep apnea. Many of these children have not had any severe throat infections. To cure such children from their obstructive problems, without influencing the immunological function of the tonsils, tonsillotomy (TT) with CO2-laser was performed in a randomized study comparing it to regular tonsillectomy, with special attention to postoperative pain and symptom recurrence. METHOD: 41 children 3.5-8 years-old were included--21 'TT's' and 20 'TE's'. They were all operated under the same anesthesia and followed the same postoperative scheme for analgesia. A visual analogue scale for pain measurements with faces was used for the first 24 h. After that, each day until pain-free, the parents registered the child's pain on a three graded scale, what the child was able to eat, and the amount of analgesic drugs used. RESULTS: all the children were cured from their breathing obstruction. The mean time used for the surgery was the same and no postoperative bleeding was seen in either group. 'TT children' were pain-free after 5 days and 'TE children' after 8 days. Eight to ten days after surgery, the TT-children had gained weight and the TE children lost weight significantly. The TE group used twice as much analgesic drugs as the TT group during the first postoperative week. The TT group was healed with normal-looking, but small tonsils after 8-10 days; the TE group often still showed edema and crusts. At the one-year follow-up 2/21 among the 'TT-children' snored, but did not require re-surgery. CONCLUSION: tonsillotomy is much less painful than TE and children recover more quickly. Results with respect to breathing obstruction are almost the same for both methods at 1-year follow-up.     

The effect of ketoprofen on recovery after tonsillectomy in children: a 3-week follow-up study.

OBJECTIVE: To evaluate recovery after tonsillectomy in children, and to determine the safety and efficacy of ketoprofen in pain treatment after discharge. STUDY DESIGN: A prospective, longitudinal study in 102 children undergoing tonsillectomy. METHODS: All children underwent tonsillectomy under a same general anesthesia. At discharge, all patients were prescribed ketoprofen capsules at a dose of 3-5 mg(-1) kg(-1) per 24 h for postoperative pain control at home, with paracetamol or paracetamol-codeine tablets for rescue analgesia. At home, the patients recorded pain and analgesic consumption each day for the first week after surgery. At 3 weeks, patients recorded the total analgesic requirement, duration of pain, and all adverse events during recovery and return to normal daily activities. RESULTS: The median of pain cessation was 9 days (range 1-20 days) and the median duration of analgesic treatment was 10 days (4-19 days). More than 50% of the patients needed rescue analgesic daily during the first week after tonsillectomy. Ketoprofen combined with paracetamol or paracetamol-codeine provided sufficient analgesia for most children. However, the analgesic action of drugs was too short to achieve pain relief, which allow undisturbed sleep during the first postoperative nights. A return back to normal daily activities took place after 9 days (2-26 days). The influence of age for pain pattern was negligible. Five patients needed electrocautery to stop postoperative bleeding. No other serious adverse-events occurred. CONCLUSIONS: The main problem after tonsillectomy is significant pain that may last 9 days or longer after surgery. Ketoprofen combined with paracetamol-codeine seems to provide a sufficient analgesia, but before ketoprofen may be recommended for children during tonsillectomy a larger study is needed to show whether or not ketoprofen increases the hemorrhage rate.     

Peritonsillar infiltration with tramadol improves pediatric tonsillectomy pain

Pain control in pediatric patients undergoing tonsillectomy remains a dilemma. Tramadol is reported to be an effective analgesic. This prospective, double-blinded, placebo-controlled study was performed to evaluate the analgesic efficacy and safety of submucosal infiltration of tramadol on postoperative pain in children after standard bipolar diathermy tonsillectomy. Following standard bipolar diathermy tonsillectomy was performed, 40 patients were randomized to receive submucoasl infiltration with 2 mg kg⁻¹ tramadol in 3 ml of normal saline (1.5 ml per tonsil) or normal saline only. The patients in each group were compared postoperatively with regard to the quality of pain control using the objective pain scale (OPS), sedation score and their analgesic requirements. Peritonsillar infiltration of tramadol (group 2) provided superior postoperative analgesia to placebo (group 1) for 4 h after surgery. In addition, group 1 received significantly more doses of paracetamol than group 2 in order to maintain analgesia in the first 12 h after recovery from anesthesia. Peritonsillar infiltration of tramadol appears to be an effective method of providing superior analgesia in the postoperative period when compared to placebo.     

Recovery after tonsillectomy in adults: a three-week follow-up study.

OBJECTIVE: To evaluate recovery after tonsillectomy and safety and efficacy of ketoprofen in pain treatment after discharge. STUDY DESIGN: A prospective, longitudinal study of 102 patients undergoing tonsillectomy. METHODS: All patients underwent tonsillectomy (or adenotonsillectomy) under general anesthesia. In the hospital, 77 patients received a bolus of 0.5 mg/kg ketoprofen intravenously, followed by a 3-mg/kg continuous infusion over 24 hours, and oxycodone for rescue analgesia. Twenty-five patients received normal saline and oxycodone. At discharge, all patients were prescribed ketoprofen capsules at a dose of 3 to 5 mg/kg per day for postoperative pain control at home, with paracetamol-codeine tablets for rescue analgesia. At home, the patients recorded pain and analgesic consumption each day for the first week after surgery. At 3 weeks, patients recorded the total analgesic requirement, duration of pain, all adverse events during recovery, and return to normal daily activities. RESULTS: No pre-emptive effect of ketoprofen was noticed because there was no significant difference in recovery after discharge between patients who had received ketoprofen or placebo during the first 24 hours after surgery. In the whole study group, the median of pain cessation was 11 days (range, 3-24 days) and the median of analgesic treatment was 12 days (range, 5-25 days). More than 50% of the patients needed 1 to 3 rescue analgesic doses daily during the first week after tonsillectomy. A return back to normal daily activities took place after 12 days (range, 2-24 days). Nine patients needed electrocautery to stop postoperative bleeding. No other serious adverse events occurred. CONCLUSIONS: The main problem after tonsillectomy is significant pain that can last 11 to 12 days after surgery. Ketoprofen combined with paracetamol-codeine provided sufficient analgesia for most patients at home, but because ketoprofen may cause an increase in the secondary hemorrhage rate, it should be prescribed with caution.     

Relief of posttonsillectomy pain with low-dose tramadol given at induction of anesthesia in children

OBJECTIVE: Pain is major problem regarding quality of life in children undergoing tonsillectomy. Preemptive analgesia by medicine given before commencement of surgery is a new way recommended for relief of pain during and after operation. The purpose in this study to evaluate preemptive efficacy and safety of lower dose of tramadol, which was recently introduced in children undergoing tonsillectomy. METHODS: This study was performed on 45 children undergoing tonsillectomy with or without adenoidectomy as a double-blinded trial, by using tramadol in two dosages (1 and 0.5 mg kg(-1)) and placebo. Pain assessment was done by facial pain score (FPS), visual analog scale (VAS) and postoperative analgesic requirement; further, duration of anesthesia and duration of awakening time, heart rate (HR) and mean arterial pressure (MAP) during and after anesthesia, postoperative nausea and vomiting (PONV) and recall of intraoperative events were recorded. RESULTS: It was found that 73% children in placebo group needed analgesic medicine at the end of the first hour after operation, although no analgesic medicine was needed in tramadol groups (chi(2) test, P<0.001). However, statistically significant decrease in FPS and VAS in tramadol groups were only found up to 15th and 30th min after operation, respectively (Kruskall-Wallis test, P<0.05). On the other hand, intraoperative HR (10th, 20th and 30th min) and MAP (10th and 20th min) were found to be higher in placebo groups (ANOVA variance analysis, Tukey-Kramer test adjusted paired t-test, P<0.001 and <0. 01, respectively). No significant difference was found in the other parameters, and no surgical complication and adverse side effect were occurred in this number of study sample. CONCLUSION: Tramadol in lower doses (0.5-1 mg kg(-1)) was an efficient preemptive analgesic that could be used at induction of anesthesia in adenotonsillectomies of children for providing both good analgesia during operation as supplementation to propofol anesthesia and postoperative analgesia in only early period.     

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

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

Ketoprofen and fentanyl for pain after uvulopalatopharyngoplasty and tonsillectomy

OBJECTIVES: The treatment of postoperative pain after uvulopalatopharyngoplasty (UPPP) and tonsillectomy presents a challenge. Opioids can cause sedation and respiratory depression. Nonsteroidal antiinflammatory drugs can increase postoperative bleeding. The authors have evaluated the severity of postoperative pain and the consumption of opioid in 53 adult patients undergoing either UPPP or tonsillectomy. STUDY DESIGN: A prospective, parallel-groups study. METHODS: A general endotracheal anesthesia was used in each patient. After surgery patients received ketoprofen 1 mg/kg as an intravenous bolus, followed by a continuous infusion of 4 mg/kg during 24 hours. For rescue analgesia patient-controlled intravenous fentanyl was used. RESULTS: Both UPPP and tonsillectomy are associated with intense postoperative pain. More than 40% of the patients had high pain scores during the first 24 postoperative hours. Postoperative pain after UPPP was more severe and the difference was significant during swallowing (P < .05). The need for fentanyl in the UPPP group was twice that of the tonsillectomy group (P < .01). There was a high interindividual scatter in the patient-controlled fentanyl attempts in both groups. The patients in the UPPP group needed significantly more oxygen supply during recovery (P = .007). No serious adverse effects occurred and none of the patients experienced postoperative bleeding that required any intervention. CONCLUSION: Individually tailored analgesic treatment protocol is essential for patients undergoing UPPP and tonsillectomy to ensure safe and effective pain alleviation.     

Ketamine in post-tonsillectomy pain

OBJECTIVE: There has yet been no ideal method for postoperative analgesia in children. Ketamine demonstrates a potent analgesic effect by central blockage of perception of pain with sub-anesthetic doses. Preoperative intramuscular administration of ketamine for sedation decreases the pain during swallowing after tonsillectomy, while it provides long-term analgesia when applied around the incision. The aim of this study is to compare the effectiveness of ketamine administered to the tonsillar region following tonsillectomy for postoperative pain management. METHODS: After obtaining consent from the local ethics committee and the parents, 60 patients from the ASA groups I and II, between 3 and 7 years of age, planned for adenotonsillectomy as outpatients, were included in the study. Subjects were randomly assigned to two equal groups and 2ml 0.9% saline for group S, and 0.5mgkg(-1) ketamine and saline 2ml in volume for group K were administered into the tonsillar region. All subjects were monitored in a standard manner and SpO(2), systolic arterial pressure (SAP), and cardiac pulse rates were recorded in 5min intervals. The CHEOPS and Wilson sedation scale were used to evaluate pain levels and sedative condition, respectively. Nausea and vomiting scores of the subjects were also noted. The time of the first analgesic administration and the total amount of analgesics in an 8-hour period were recorded. Student-T and Chi-Square tests were used for the statistical evaluation of the data and a p value of <0.05 was accepted as significant. RESULTS: There were no significant differences between groups according to age, sex, weight, intermittent SAP and cardiac pulse rates. However, the CHEOPS value, the first analgesic need and the total amount of analgesic need were in favor of ketamine (p<0.05). CONCLUSIONS: In previous studies, no significant differences were demonstrated in pre-emptive analgesia with ketamine, magnesium, morphine, and clonidine. The dose of ketamin and the volume used in this study caused no sedation or nausea and provided a high level of analgesia. Ketamine infiltration into the tonsillar region after tonsillectomy was found to be easy and effective.     

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

Post‐operative pain is the main cause of morbidity following tonsillectomy. The efficacy of glossopharyngeal and lesser palatine nerve blocks in controlling postoperative pain in adult patients was investigated prospectively. Patients 16 years and older admitted for elective tonsillectomy were randomised to one of three groups to receive a pre‐incisional oropharyngeal injection of 0.5% bupivicaine, a ‘dummy’ injection of saline or no injection. Dissection tonsillectomy and general anaesthetic techniques were standardized. Postoperative pain was monitored for 24 h. anova , χ² and Fisher's exact test were used for intergroup comparisons. Ninety‐two patients (72 women and 20 men), mean age 22 years were studied. Twenty‐nine patients received 0.5% bupivicaine, 30 saline and 33 no pre‐incisional injection. The overall mean pain scores of 2.1, 1.9 and 1.9 in the bupivicaine, saline and no injection groups were similar. Glossopharyngeal and lesser palatine 0.5% bupivicaine nerve blocks are not effective in reducing early post‐tonsillectomy pain.