Is Diclofenac Gargle Effective in Alleviating Post-Tonsillectomy Pain in Adults?

Introduction: Pain in the post-operative period is a major concern following tonsillectomy in an adult resulting in prolonged hospital stay, decreased oral intake and absence from work. Various techniques and medications have been tried to reduce the pain. Objectives We attempted to study the efficacy of diclofenac gargle in reducing the post-tonsillectomy pain in adults. Methodology We conducted a double-blind randomized study in patients 18 years or older undergoing tonsillectomy. Cases were given diclofenac gargle in post-operative period whereas controls were given normal saline gargle. Other modality of treatment and medication were same in both the groups. Pain was assessed at rest and during swallowing with Visual Analogue Score (VAS) on first and second post-operative day, and then at the end of first and second week of the surgery. Pain scores between two groups were compared. Results There were 64 participants equally divided into cases and controls by block randomization. Pain score during swallowing was significantly less in cases. The difference at rest was not significant at any point of time studied. The pain gradually increased over a week in both the groups and then rapidly decreased by the end of second week. Conclusion Diclofenac gargle is effective in reducing the posttonsillectomy pain, especially during swallowing, in adults.

Standardization and Reduction of Narcotics After Pediatric Tonsillectomy

Objectives (1) To measure caregiver satisfaction with a nonstandardized postoperative pain regimen after pediatric tonsillectomy. (2) To implement a quality improvement project (QIP) to reduce the number and volume of narcotics prescribed and to describe the effect on caregiver satisfaction. Methods A prospective cohort study at a tertiary children’s hospital examined postoperative narcotics prescribed to children following adenotonsillectomy. A QIP was implemented 3 months into the observation, with the goal to standardize nonnarcotic analgesics and reduce the volume of narcotics prescribed. Caregivers were called 2 to 3 weeks postoperatively to assess pain control and caregiver satisfaction. Results Over an 8-month period, 118 patients were recruited (66 before the QIP, 52 after induction). Prior to the QIP, 47% of patients were prescribed postoperative narcotics, as opposed to 27% after the QIP ( P < .05). There was a significant reduction in the volume of narcotics prescribed before (mean ± SD, 300 ± 150 mL) versus after (180 ± 111 mL) the initiative ( P < .05). The per-kilogram dose did not change over the study time frame. On a 5-point Likert scale, there was no difference in the caregivers’ satisfaction regarding pain control before (4.37 ± 0.85) versus after (4.35 ± 1.0) the project started. Discussion A system shift was identified with the establishment of a posttonsillectomy pain control protocol associated with a reduction in prescribed narcotics without a significant change in caregiver satisfaction. Implications for Practice Implementing a standardized plan for the use of nonnarcotic medications was associated with reduced frequency and volume of narcotics prescribed. Future work will further standardize our postoperative pain regimen.

Was essen nach Tonsillektomie?

Faramarzi M et al. Comparing Cold/Liquid Diet vs Regular Diet on Posttonsillectomy Pain and Bleeding. Otolaryngol Head Neck Surg 2018; 159: 755–760 Die Tonsillektomie ist eine häufige Operation. Hinsichtlich Nahrungsmittelauswahl und Art der Ernährung nach der Tonsillektomie gehen die Meinungen aber auseinander. Ärzte des HNO-Forschungszentrums in Schiras im Iran verglichen die Auswirkungen einer kalt/flüssigen Diät und einer normalen Ernährung auf Schmerzen und Blutungen im Bereich der Tonsillektomie.

A Randomized Single-Blinded Trial of Posttonsillectomy Liposomal Bupivacaine among Adult Patients

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.