Peritonsillar infiltration of lidocaine Hcl versus intravenous pre-incisional lornoxicam in reducing post-tonsillectomy pain: this is a prospective, randomized, double-blinded, placebo-controlled study

Background Tonsillectomy is one of the most common procedures in otorhinolaryngology practice where analgesics are required for pain-relief especially in children. To compare the efficacy of using peritonsillar infiltration of lidocaine Hcl versus intravenous preincisional lornoxicam in reducing post tonsillectomy pain. Results Prospective, randomized, double-blinded, placebo-controlled study. Ninety-nine patients from age 12 to 18 years old, prepared for tonsillectomy. Patients were randomly subdivided into three groups as 33 patient in each group to receive either lidocaine (group 1), lornoxicam (group 2), or saline as a placebo (group 3). Anesthesia was induced using intravenous fentanyl and propofol, while endotracheal intubation was facilitated with rocuronium and maintenance by halothan. Intraoperative bleeding, pain scores, interval until first order for analgesic. The postoperative complications including bleeding, hypoxia, nausea, and vomiting also were observed. Pain scores at rest were significantly lower in group 2 than groups 1 and 3 at all observation times. Similarly, pain scores were lower in group 2 during the first 5 postoperative hours. The mean time for rescue analgesic was 276 min in group 2, 91 min in group 1, and about 60 min in group 3. No significant differences were noted for intraoperative bleeding. Conclusion The use of lornoxicam 16 mg at preoperative phase gave good control of immediate post tonsillectomy pain. Level of evidence 3b

A Comparative study of intraoperative peritonsillar infiltration versus intravenous dexemedetomidine for perioperative analgesia in tonsillectomy

Background: Tonsillectomy is one of the most common surgical procedures in population and post tonsillectomy pain affects analgesic consumption, hospital stay, oral intake and return to regular activity. Aims and Objectives: The purpose of the study was to compare peritonsillar infiltration and intravenous administration of dexmedetomidine for perioperative analgesia in tonsillectomy. Materials and Methods: This was a placebo-controlled study to compare peritonsillar infiltration and intravenous administration of dexmedetomidine in patients undergoing tonsillectomy. Ninety patients were included in this study on the basis of a predefined inclusion and exclusion criteria. These patients were divided in 3 groups on the basis of whether they received Peritonsillar dexmedetomidine, intravenous dexmedetomidine or intravenous normal saline. The groups were compared for post-operative pain, time to first request of rescue analgesia (duration of analgesia), post-operative sedation, analgesic requirement during first 24 hours and side effects. SSPS 21.0 was used for statistical analysis and p value less than 0.05 was taken as statistically significant. Results: Out of total 90 patients included in this study there was a female preponderance with a M: F ratio of 1:1.5. The mean age and ASA grades and mean duration of surgery of patients in all 3 groups were found to be comparable with no statistically significant difference in any of the groups (P>0.05). Preoperative mean systolic and diastolic blood pressures as well as mean arterial pressure and SPO2 was found to be comparable in all 3 groups. However intraoperative blood pressures (systolic, diastolic as well as mean arterial pressures) and SPO2 showed significant difference amongst the groups (P<0.05). Time to first request of rescue analgesia was found to be more in group - Dpt than group – Div and group – Pb which was highly statistically significant (p <0.0001).There was statistical significant difference in number of diclofenac injections consumed during first 24 hours between group – Dpt & group – Div and highly significant difference between group – Dpt & group – Pb, group – Div & group – Pb. Conclusion: Peritonsillar infiltration of dexmedetomidine is better alternative to intravenous dexmedetomidine in tonsillar surgeries.

Comparison of analgesic effect of peritonsillar infiltration with bupivacaine versus bupivacaine-dexamethasone in children undergoing tonsillectomy.

Objective: To compare analgesic effect of peritonsillar infiltration with bupivacaine versus bupivacaine-dexamethasone in children undergoing tonsillectomy. Study Design: Randomized Control study. Setting: Aziz Fatimah Hospital, Faisalabad. Period: 01-03-2018 to 31-12-2018. Material & Methods: 80 patients were enrolled in the clinical study using non-probability consecutive sampling technique. They were divided into two groups, before start of surgery group BD received peritonsillar infiltration of bupivacaine and dexamethasone combination, whereas group B received local infiltration of bupivacaine only. Primary outcome measures were pain score recorded immediately after recovery of patient (0 hour) and at 2, 6, 12 and 24 hours after surgery and requirement for analgesia postoperatively. Other parameters recorded were time to first oral intake and sleep pattern over 24 hours. Results: Mean pain scores in group BD were 0.075, 0.225, 1.675, 0.75, 0.275 and in1 group B were 0.65, 0.975, 2.95, 1.5, 0.95 at 0, 2, 6, 12, 24 hours postoperatively respectively. 92.5% patients in group BD and & 57.5% in group B had good sleep whereas 7.5% in group BD and 42.5% in group B had disturbed sleep. 6 patients in BD group and 26 in B group required analgesia. Conclusion: Our study concluded that infiltration of tonsillar fossa with bupivacaine – dexamethasone prior to the start of surgery provides better postoperative analgesia, early start of oral intake, less rescue analgesic requirements and better sleep pattern.

Assessment of the utility of ultrasonography and microbiology in the treatment of peritonsillar abscess in children

Introduction. Peritonsillar abscess is the most common deep neck and head space infection. It mostly occurs in young adults and teenagers, usually during the infectious season; at the turn of November and December as well as April and May. The peak incidence coincides with the highest incidence of streptococcal pharyngitis. Aim. A clinical analysis was performed in patients with peritonsillar abscess symptoms to determine the role of ultrasound imaging as a diagnostic tool confirming this condition. Material and methods. A retrospective, non-randomised study conducted in a group of 20 patients aged between 1 and 17 years, who were hospitalised due to peritonsillar abscess or infiltration in the Department of Paediatric Otolaryngology. Ultrasonography of the neck was performed in all patients in the study group to assess the presence of a fluid reservoir on the symptomatic side. Results. Ultrasound imaging revealed the presence of fluid indicative of abscess in 12 cases. Incision and puncture were performed in all these patients. Purulent content was obtained in 11 cases. Conclusions. Ultrasound was found useful in detecting the presence of an abscess and differentiating between peritonsillar infiltration and abscess.