Treatment of primary snoring using modified radiofrequency-assisted uvulopalatoplasty

Snoring is a common complaint, especially among the elderly individuals. In the treatment of snoring, many options, surgical or nonsurgical, are available. In this randomized study, we used a modified technique including some components of radiofrequency-assisted uvulopalatoplasty (RAUP) and Uvulopalatopharyngoplasty UPPP (modified-RAUP, MRAUP) and RAUP in a control group. A total of 60 patients (58 male and 2 female), 30 in each group (MRAUP and RAUP groups), with an average age of 38 ± 9 years were included in the study. In the MRAUP group, in addition to the modified surgery, preoperative steroid injection was used as a preemptive analgesic and pre-incisional steroid injection and closure of the edges of the incision were performed to achieve better relief of pain. Snoring score, pain at rest and during swallowing, analgesic consumption and speech score were evaluated using standard 10 cm visual analog scales (VAS). Operation time and other complications were recorded. The patients in the MRAUP group had better pain scores, both at rest and during swallowing, and less analgesic consumption. Although operation time was longer in the MRAUP group compared to that of the RAUP group, snoring score, evaluated from day 1 to the 6th month after operation, was significantly better in the MRAUP group. Postoperative speech scores at each visit were similar in both groups. In the MRAUP group, 87% of the patients (26 patients) had a final VAS for snoring below 3, while in the RAUP group 63% of the patients (19 patients) were below 3 on the scale (P < 0.05). Thus, MRAUP seems to be a promising technique for surgery as a treatment for snoring.     

Topical bupivacaine compared to bupivacaine infiltration for post-tonsillectomy pain relief in children: a prospective randomized controlled clinical study

The objective of this study is to compare the topical administration of bupivacaine hydrochloride, saline and bupivacaine hydrochloride infiltration on post-tonsillectomy pain in children. Sixty children undergoing tonsillectomy were enrolled in the study. Patients were randomized into three groups using sealed envelopes. Group 1 (n = 20) received topical 0.5 % bupivacaine hydrochloride, group 2 (n = 20) received topical 0.9 % NaCl (saline), and group 3 (n = 20) received 0.5 % bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated using McGrath’s face scale. Pain scores in topical bupivacaine hydrochloride group was significantly lesser than the topical saline group at 5th, 13th, 17th and 21st hours, until the 6th day (p < 0.017). Moreover, pain scores of topical bupivacaine hydrochloride group was superior to bupivacaine hydrochloride infiltration group at 5th, 13th, 17th hours and 2nd, 3rd, 4th and 5th day (p < 0.017). There were significantly lesser morbidities in topical bupivacaine hydrochloride than saline group in 1st and 4th day (p < 0.017). Topical administration of bupivacaine hydrochloride proved to provide more efficient pain control than bupivacaine hydrochloride infiltration.     

The effects of levobupivacaine infiltration on post-tonsillectomy pain relief in adults: a single-blinded, randomized, and controlled clinical study

The aim of this prospective single-blinded and controlled study is to evaluate the efficacy of levobupivacaine infiltration on post-tonsillectomy pain relief in adults. The study was conducted with 40 adult patients who underwent tonsillectomy. These patients were randomized in either study group (SG) who received levobupivacaine infiltration to peritonsillary fossae prior to surgery or control group (CG) with no medication. After surgery, all the patients were queried for pain scores by visual analog scale. In addition, the volume of intraoperative bleeding, the duration of operation, the severity of postoperative complications, and the amount of analgesic requirement were the other outcome measures of this study. There were significant differences between groups regarding pain scores for the first 24 h in favor of SG. The analgesic requirement was also significantly lower in SG (p = 0.009). Although there was a sustained decrement at pain score during first 24 h for SG, however, the change from baseline score (immediate score) for each time interval revealed no significance compared to CG. In addition, the duration of operation and the volume of intraoperative bleeding were similar (p = 0.64 and p = 0.165). In conclusion, preincisional infiltration of levobupivacaine is a safe and reliable method for post-tonsillectomy pain reduction in adults. However, more in-depth, double-blinded and placebo controlled studies are required to elucidate its long term benefits.     

Pre-emptive peritonsillar dexamethasone vs. levobupivacaine infiltration for relief of post-adenotonsillectomy pain in children: A controlled clinical study

Objectives

To investigate the effects of the pre-emptive local infiltration of dexamethasone vs. levobupivacaine on postoperative pain and morbidity in pediatric adenotonsillectomy patients.

Methods

A total of 60 patients (32 males and 28 females), aged 3–14 years, were included in this double-blind prospective randomized controlled clinical study from September of 2011 until May of 2012. Patients admitted for adenotonsillectomies after informed consent was obtained from the parents, and randomized into three groups receiving either dexamethasone sodium phosphate (Group 1, mean age 5.9 ± 1.6), levobupivacaine with epinephrine (Group 2, mean age 6.1 ± 2.6), or saline (Group 3, mean age 6.0 ± 3.4). Pain scores at the 1st, 4th, 8th, 12th, 16th, and 20th hours, and first, second, third and seventh days post-operatively were recorded by the parents using McGrath’s face scale. The operation type, operation time and anesthesia time, the time of the first request for postoperative analgesia, and the total number of analgesic interventions were recorded.

Results

Pain scores were revealed in this order: Group 1 (steroid) < Group 2 (levobupivacaine) < Group 3 (saline) at all times (p = 0.000). The anesthesia times for Group 1 and Group 2 were different (steroid vs. levobupivacaine), and the time to first analgesic was longer in Groups 1 (steroid) and 2 (levobupivacaine) than in Group 3 (saline) (p < 0.000). The total number of analgesic interventions was lower in Group 1 (steroid) than in Group 2 (levobupivacaine) and Group 3 (saline) (steroid vs. saline, p = 0.000, and steroid vs. levobupivacaine, p < 0.05).

Conclusion

Peritonsillar dexamethasone infiltration was more effective than both levobupivacaine and saline in reducing post-tonsillectomy pain. It was proven to be a safe and effective method.     

Dexamethasone reduces pain after tonsillectomy in adults

The aim of this study was to assess the effect of a course of dexamethasone on postoperative pain and morbidity after adult tonsillectomy. We report the results of a double-blind, randomized, placebo-controlled trial of 200 adult patients undergoing elective tonsillectomy. Patients were randomized to three groups: one group received the non-steroidal anti-inflammatory drug piroxicam for 8 days postoperatively, one group received dexamethasone for the same period and the third group received both drugs. Patients recorded their pain scores and analgesic requirements daily for 10 days. Patients treated with a combination of piroxicam and dexamethasone recorded consistently lower pain scores than those treated with either drug alone. This difference was statistically significant (P < 0.05) on all days except the day of surgery and the second postoperative day. Patients treated with piroxicam alone had significantly higher analgesic requirements than in either of the other groups. Dexamethasone given in this regime reduces postoperative pain and analgesic requirements after adult tonsillectomy.     

The effect of fusafungine on post-operative pain and wound healing after pediatric tonsillectomy

OBJECTIVE: To investigate the effect of fusafungine spray on pain and healing process after pediatric tonsillectomy. METHODS: Sixty children with ages between 4 and 14 years underwent tonsillectomy or adenotonsillectomy. The patients were randomly divided into three groups and each group consisted of 20 patients. Group 1 was treated with antibiotic (amoxicillin-clavulanic acid) plus analgesic (acetaminophen), group 2 was treated with fusafungine plus analgesic (acetaminophen) and group 3 was treated with only fusafungine. The average ages were 7.8 + 3.4, 6.6 + 2.9, and 8.2 + 3.7 for groups 1, 2, and 3, respectively. Clinical evaluations were made after the operation on the 1st (T1), 3rd (T3), 7th (T7), 10th (T10), and 14th days (T14). RESULTS: There was no significant difference in post-operative pain between study groups on the post-operative 1st, 3rd, and 7th days (P > 0.05), a statistically significant difference was present between groups 1 and 3, and groups 1 and 2 on the post-operative 10th and 14th day (P = 0.018 and 0.037, respectively). Pain was less in groups 2 and 3 than in group 1 on the 10th and 14th day. Also there was a significant difference in healing time of the tonsillary beds between groups 1 and 2, and groups 1 and 3 on the 10th and 14th post-operative day (P = 0.031 and 0.001, respectively). Healing was better in groups 2 and 3 than in group 1 on the 10th and 14th day. CONCLUSION: Fusafungine administration after tonsillectomy was found to be beneficial on post-operative pain and wound healing of tonsillary beds in pediatric population.     

The effects of dexamethasone,bupivacaine and topical lidocaine spray on pain after tonsillectomy

OBJECTIVE: To compare the administration of bupivacaine hydrochloride, dexamethasone and lidocaine hydrochloride in decreasing post-tonsillectomy pain. METHODS: Eighty patients were enrolled in the study in ENT Clinic, Firat University, and in ENT Clinic Elazi? SSK Hospital, Elazi? (Turkey). Children between 6 and 14 years of age referred to our department for bilateral tonsillectomy for either recurrent tonsillitis or tonsillar hypertrophy. Data from 80 patients were analyzed. The first group had bupivacaine hydrochloride. The second group had dexamethasone infiltrated around each tonsil. The third group was given equal doses of 10% lidocain hydrochloride sprayed on the tonsillectomy fossa four times a day, and a placebo group received 9% NaCl applied to the tonsillar fossa four times a day. Pain scores, determined by visual analog scale, were obtained in the first, third and seventh postoperative days. RESULTS: Pain scores in the postoperative period were identical in the first, third and seventh postoperative days. According to VAS results the groups were compared on the basis of postoperative pain. In the first postoperative day, the difference between bupivacaine-placebo, dexamethasone-placebo and lidocaine-placebo groups was found to be statistically significant (P<0.05). Nevertheless the difference between bupivacaine-dexamethasone, bupivacaine-lidocaine and dexamethasone-lidocaine were not significant (P>0.05). In the third postoperative day, the difference between bupivacaine and lidocaine group found to be statistically significant (P<0.05). In the seventh post-operative day the results of bupivacaine, dexamethasone, lidocaine and placebo groups were similar (P>0.05). CONCLUSION: Bupivacaine, Dexamethasone and Lidocaine nasal aerosol decreased the pain significantly in the first postoperative day when it was compared with the placebo group. These three medicines can be used to reduce pain for children during the postoperative period applied tonsillectomy during the post-operative period. But lidocaine was more preferable, reducing pain in the third postop day better than bupivacaine.     

The evaluation of ozone and betahistine in the treatment of tinnitus

The aim of the study is to evaluate the effectiveness of ozone and betahistine treatments in the treatment of tinnitus. Sixty-eight patients were enrolled in this randomized, prospective controlled study. The ozone group consisted of 27, betahistine group consisted of 26 and control group consisted of 15 patients. The patients in ozone group received 10 sessions of ozone treatment via major autohemotherapy. Betahistine group received 48 mg/day betahistine tablets per oral for 3 months duration. The control group was followed up without any treatment given. The evaluation of tinnitus was made by tinnitus loudness and tinnitus handicap inventory (THI). The changes in findings from baseline to 3rd and 6th months were assessed, and the group results were compared. Comparison of the initial mean tinnitus loudness and 3 and 6 months after treatment in each of the three groups did not reveal a significant difference. The comparison between the groups in terms of the improvement of tinnitus loudness was not significant (p = 0.821). Comparison of the initial mean THI and 3 and 6 months after treatment revealed a significant difference in ozone and betahistine groups but not in the control group. When the delta (Δ) THI (the change of mean THI between the initial and 6th month) was compared between the groups, there was no significant difference. This randomized controlled study investigating the effects of ozone in tinnitus tries to shed light to a new method of treatment in tinnitus. The findings of the study does not provide enough evidence to support ozone and betahistine as a treatment for tinnitus and further research on the subject is necessary.     

The effects of levobupivacaine versus levobupivacaine plus magnesium infiltration on postoperative analgesia and laryngospasm in pediatric tonsillectomy patients

BACKGROUND: The aim of this study was to evaluate whether the addition of magnesium to levobupivacaine will decrease the postoperative analgesic requirement or not, and to investigate the possible preventive effects on laryngospasm. METHODS: Seventy-five children undergoing elective tonsillectomy and/or adenoidectomy surgery. The drug was prepared as only NaCl 0.9% for the first group (Group S, n=25), levobupivacaine 0.25% for the second group (Group L, n=25), and levobupivacaine 0.25% plus magnesium sulphate 2mg/kg for the third group (Group M, n=25). Pain was recorded at 15th minute, 1st, 4th, 8th, 16th, and 24th hour postoperatively. Pain was evaluated using a modified Children's Hospital of Eastern Ontario pain scale (mCHEOPS). Incidence of postoperative nausea and vomiting (PONV) was assessed at various time intervals (0-2, 2-6, 6-24h) by numeric rank score. Patients were followed for laryngospasm for 1h in recovery room after extubation. Other complications appeared within 24h postoperatively were recorded. RESULTS: All postoperative CHEOPS values were lower than control in both groups. Analgesic requirement was decreased significantly in both groups in comparison with control patients, but this requirement was significantly lower in Group M (p<0.05). Although laryngospasm was not observed in Group M, the difference between groups was not statistically significant. PONV was similar in both groups. CONCLUSIONS: Levobupivacaine and Levobupivacaine plus magnesium infiltration decrease the post-tonsillectomy analgesic requirement. Insignificant preventive effect of low doses of magnesium infiltration on laryngospasm observed in this study needs to be clarified by larger series.     

Does cooling the tonsillar fossae during thermal welding tonsillectomy have an effect on postoperative pain and healing?

The objective of this study was to evaluate the effect of cooling the tonsillar fossa during thermal welding tonsillectomy on pain and wound healing. Prospective, blinded, clinical study was conducted. 30 patients who underwent tonsillectomy by thermal welding were evaluated. When one of the tonsillar fossa was cooled by isotonic fluid, the other has left untreated. Postoperative pain and mucosal healing pattern were assessed. Data were recorded and statistically analyzed. Healing process of the cooled down tonsillar fossae were significantly better on the 7th and 14th postoperative day (p < 0.01). Control tonsillar fossae had significantly higher pain scores on the 3rd, 7th and 14th postoperative day (p < 0.05). Administration of isotonic fluid, during thermal welding tonsillectomy for cooling tonsillar fossae, accelerates wound-healing process significantly and decreases tonsillectomy related pain complaints post-operatively.     

Systemic dexamethasone for the prevention of cisplatin-induced ototoxicity

Ototoxicity is a common side effect of cisplatin chemotherapy. This study was undertaken to determine the potential protective effects of a systemic administration of dexamethasone against cisplatin-induced ototoxicity. A prospective controlled trial conducted in an animal model. The setting was Animal care research facilities of the Montreal Children’s Hospital Research Institute. An experimental guinea pig model was used. The animals were divided as follows: group 1 (n = 10): 12 mg/kg intraperitoneal (IP) cisplatin, group 2 (n = 14): 15 mg/kg/day dexamethasone IP for 2 days followed by cisplatin 12 mg/kg IP, group 3 (n = 14): 10 mg/kg/day dexamethasone IP for 2 days, on day 3, they received cisplatin 12 mg/kg IP followed by 20 mg/kg/day dexamethasone for 2 days and group 4 (n = 5): 10 ml of saline IP twice a day for 3 days. Auditory brainstem response (ABR) threshold shifts were measured at four frequencies (8, 16, 20 and 25 kHz) for groups 1, 2 and 3. Histological changes in the organ of Corti, the stria vascularis, the spiral ligament and the spiral ganglion neurons as well as scanning electron microscopy for outer hair cells were completed. Immunohistochemistry for tumour necrosis factor-alpha (TNF-α) was performed. ABR threshold shifts were similar in all groups. Histological and scanning electron findings demonstrate that dexamethasone has greater protective effect on the stria vascularis. Systemic dexamethasone administration in a guinea pig model did not provide significant protection against cisplatin-induced ototoxicity. Dexamethasone may be useful in future applications as a complementary treatment.     

EMLA® cream as local anesthetic for radiofrequency turbinate tissue reduction

Radiofrequency volumetric tissue reduction is a minimally invasive technique in the treatment of turbinate hypertrophy and is generally performed under local anesthesia. However, perioperative discomfort and pain are common side effects and studies concerning the technique of choice to anesthetize the nasal mucosa in this procedure are lacking. The aim of this prospective controlled trial is to assess the effectiveness of EMLA^® cream as a topical anesthetic for radiofrequency volumetric tissue reduction of inferior turbinates comparing its effect with that obtained using a traditional anesthetic technique. 200 consecutive patients undergoing volumetric tissue reduction with topical anesthesia were enrolled. Patients were divided into two groups: Group A included 100 patients treated by placing cotton pledgets soaked with lidocaine 10 % in the inferior meatus followed by the injection of 2 % lidocaine into the head of the inferior turbinate; Group B included 100 patients treated with EMLA^® cream. Patients were evaluated before and after surgery using rhinomanometry for obstructive symptoms. Four VAS about pain, troublesome swallowing, choking sensation and intraoperative anxiety were submitted to each patient immediately after surgery and after 2 months to assess various aspects of perioperative discomfort. A significant increase of nasal airflow was observed without differences between the two groups. Subjective evaluation regarding perioperative discomfort showed significant differences between Groups A and B immediately after surgery although it was less pronounced 2 months later. The results of this study suggest that EMLA^® cream is an efficient tool in obtaining an adequate anesthetic effect in this procedure.     

局部注射布比卡因或利多卡因对全身麻醉下儿童鼾症术后疼痛的影响

目的：比较局部注射布比卡因或利多卡因对全身麻醉下儿童鼾症术后疼痛的影响。方法：选取60例儿童鼾症患者分为3组,组1注射0．9％NaCl（生理盐水组）;组2注射0．25％布比卡因（布比卡因组）;组3注射2％利多卡因（利多卡因组）。采用面部表情模拟评分（McGrath’s facescale）记录术后2、6、12、18h和术后1、2、3、4、5、6、7d疼痛强度。结果：术后2、6h,3组疼痛值相似,差异无统计学意义（P〉O．05）;术后12h,布比卡因组疼痛值低于生理盐水组,有显著性差异（P（0．05）;术后18～24h直至术后7d,布比卡因组和利多卡因组疼痛值显著低于生理盐水组,有显著性差异（P（0．05）,但布比卡因组和利多卡因组比较无显著性差异（P2〉0．05）。生理盐水组的疼痛高峰在术后18h,布比卡因组和利多卡因组疼痛高峰在术后第2h且随着时间延长呈下降趋蛰．结诊．屠部沣茸寸布比卡因或利多卡因可有效减轻儿童鼾症术后疼痛．两者无显著件羊异．     

The effectiveness of low-level laser on postoperative pain and edema in secondary palatal operation

ObjectiveThe postoperative period after palatal surgery is usually very painful, requiring the use of pain-relieving drugs. Hence, the aim of this study was to evaluate the efficacy of Low-level laser therapy (LLLT) in post-operative pain control and edema after secondary palatal operations.MethodsA randomized double blinded clinical study on 20 children undergoing secondary palatal operations between 2013 and 2015 was done. Patients were randomly divided on two groups 10 patients each. In one group patients received local application of therapeutic laser immediately after surgery while patients received nothing in the control group. The mean age was 5.22 years ± 2.53 SD in the laser group and 6.42 years ± 0.76 in the control group. Postoperative pain was assessed by using visual analog scale scores and by recording the need of analgesics. The degree of postoperative edema was also recorded.ResultsThe pain scale showed significantly less postoperative pain in the laser group than in the control group from the first day (P-value = 0.006) to the 6th day (P-value = 0.014). The number of postoperative analgesic doses needed were significantly less in the laser group in the second and third days (P-value = 0.014). The postoperative edema was significantly higher in the control group from the 2nd (P-value = 0.004) to the 7th (P-value = 0.014) postoperative days.ConclusionsPreliminary results showed that low-level laser therapy is effective in the reduction of postoperative pain and edema, and minimizing the need of analgesic medication after secondary palatal operations.     

Does perioperative dexamethasone affect voice-related quality of life after thyroidectomy?

The objective of this study is to assess the impact of perioperative dexamethasone on post-thyroidectomy voice outcomes. This study is a retrospective review of prospectively collected data in a tertiary referral center. This is a retrospective analysis of prospectively collected data on adult patients undergoing total thyroidectomy. Exclusion criteria were: previous neck surgery, thyroid lobectomy, neck dissection or other procedure together with thyroidectomy, pathological findings on laryngeal examination, preoperative or postoperative steroid therapy, diabetes mellitus, pregnancy, and postoperative recurrent laryngeal nerve palsy. In all patients, flexible laryngoscopy was performed and Voice Handicap Index (VHI) scores were obtained the day before, 48 h and 1 month after surgery. Patients’ medical records were reviewed to find the patients who had received dexamethasone by the anesthesiologist as nausea and vomiting prophylaxis or analgesia. Thus, two groups of patients were formed: dexamethasone (D) group and non-steroid (NS) group. Mann–Whitney test used to compare VHI between the two groups. 122 patients fulfilled the criteria. D group consisted of 50 patients (44 females; mean age 53.16 ± 17.61), in which a single IV dose of 8 mg dexamethasone had been administered perioperative, and NS group consisted of 72 patients (58 females; mean age 50.53 ± 13.60), where no steroids had been administered. No significant difference was noticed between D and NS groups for preoperative VHI score, VHI scores 48 h and 1 month after surgery. In our study, a single perioperative IV dose of 8 mg dexamethasone did not seem to add any benefit on voice-related quality of life after thyroid surgery.     

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。     

Topical bupivacaine compared to lidocaine with epinephrine for post-tonsillectomy pain relief in children: a randomized controlled study

Objective

To compare the topical administration of bupivacaine hydrochloride, lidocaine hydrochloride with epinephrine and saline in alleviating post tonsillectomy pain.

Study design

A double-blind prospective randomized controlled clinical study.

Methods

Between November 2008 and March 2009, 60 patients (32 males and 28 females) between ages of 1.5 and 15 years were recruited into the study. After informed consent was obtained from the parents, patients, admitted for tonsillectomy, were randomized into three groups using sealed envelops. Group 1 (20 patients, mean age 5.2 ± 1.7) received topical lidocaine hydrochloride (20 mg/ml) with 0.00125% epinephrine. Group 2 (20 patients, mean age 6 ± 3.7) received topical 0.5% bupivacaine hydrochloride and group 3 (20 patients, mean age 6.7 ± 3.6) received topical saline.

Results

The post-operative pain scores at 1 h were similar among the groups (p = 0.29). Pain scores in bupivacaine hydrochloride group were significantly lesser than the saline group at 5th, 13th, 17th and 21st hours, until the sixth day (p < 0.017). Moreover, pain scores of bupivacaine hydrochloride group were superior to lidocaine hydrochloride group starting at 17 h, until fourth day (p < 0.017). Pain scores of lidocaine hydrochloride group were lesser than saline group in the first and fifth days (p < 0.017), whereas, there was no significant difference at other times.

Conclusion

Topical administration of bupivacaine hydrochloride proved to provide more efficient pain control than both saline and lidocaine without any drug related complication.     

Preemptive peritonsillar infiltration with lidocaine for relief of bipolar adult post-tonsillectomy pain: a randomized, double-blinded clinical study

There are discordant results in the studies of the peritonsillar infiltration in adults undergoing the tonsillectomy. The study is to compare the effect of the preemptive peritonsillar infiltration with lidocaine in bipolar tonsillectomy in adult. 172 adult patients were randomly located into five groups before tonsillectomy: group 0: without the peritonsillar infiltration, group 1: for 3 ml normal saline with 1:200,000 epinephrine per tonsil, group 2: for 3 ml 1 %lidocaine with 1:200,000 epinephrine per tonsil, group 3: for 8 ml normal saline with 1:200,000 epinephrine per tonsil, group 4: for 8 ml lidocaine with 1:200,000 epinephrine per tonsil. The post-operative pain in the following 7 days was assessed by visual analog scale. Operation time and post-operative bleeding were also recorded. No significant differences were found between operative times, post-tonsillectomy hemorrhage between the five groups. The differences between pain scores of the group 0, group 1 and group 2 were not statistically significant (P > 0.05). The differences between pain scores of group 3, group 4 against group 0, group 1, group 2 were statistically significant (P < 0.05). We found the volume of peritonsillar infiltration might contribute to the relief of pain of the bipolar post-tonsillectomy.     

Nasal mucosal contact points with facial pain and/or headache: lidocaine can predict the result of localized endoscopic resection

The objective of the study was conducted to evaluate the effectiveness of nasal endoscopy for both diagnosis and localized excision of intranasal contact areas that cause headache and/or facial pain as well as to evaluate the use of lidocaine test for diagnosis of such cases and predicting the result of surgery. This study included 120 patients aged between 18 and 45 years, with an average period of headache and/or facial pain of 2.5 years. Patients were classified into two groups according to lidocaine test. Group A that was lidocaine positive and group B which was negative. Excision of contact points was done, under endoscopic guidance, from the septum as well as the lateral nasal wall. 98.75% of patients in group A got benefit from surgery as most cases were cured from headache and facial pain. In group B, 40% got benefit with most patients had unchanged symptoms. In conclusion, endoscopic surgery gives a more precise complete excision of limited areas without time wasting or morbidity. Lidocaine test can be used as a test to aid in diagnosis and to predict the result of surgery where there were high cure rate within the lidocaine-positive group.     

The effect of lidocaine,bupivacaine and ropivacaine in nasal packs on pain and hemorrhage after septoplasty

We aimed to investigate the effects of local anesthetics soaked in Merocel nasal packs on hemorrhage and pain after septoplasty. The methodology includes a prospective double-blind study that was conducted in patients undergoing septoplasty because of nasal septal deviation. The study included 143 patients. The patients were divided into four groups. Each group received 1% lidocaine + 0.000625% adrenalin, 0.375% ropivacaine, 0.25% bupivacaine as study groups or 0.9% sodium chloride as a control group in their Merocel packs postoperatively. The local anesthetics or sodium chloride were reapplied at the eighth postoperative hour. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. The statistical analysis was performed using two sided t test on each patient group at each time point. The results included the patients in the control group needing rescue drug most often. There was no statistically significant difference between bupivacaine and lidocaine plus adrenalin in the patients who requested rescue drug. The patients in the ropivacaine group requested rescue drug more frequently than the bupivacaine and lidocaine plus adrenalin groups. Bupivacaine group had significantly better pain scores versus control group at all intervals except for the first postoperative hour.The bupivacaine group had better pain scores versus ropivacaine and lidocaine plus adrenalin groups in the 4th, 8th and the 24th hours. The bupivacaine group had better pain scores versus lidocaine plus adrenalin in the 12th, 16th and the 20th hours. The ropivacaine group had significantly better pain scores versus control group in the 8th, 12th, 16th, 20th and 24th postoperative hours. The ropivacaine group scored better than lidocaine plus adrenalin group just in the 16th hour. The lidocaine plus adrenalin group had significantly better pain scores versus control group in 4th and 12th hours. There was no statistically significant difference between the study groups in terms of postoperative hemorrhage. We concluded that bupivacaine use in nasal surgery provides better analgesia at least in the first 8 h period and does not cause more bleeding. Topical bupivacaine application to nasal packs should be considered after septoplasty.