A randomised controlled trial of two analgesic techniques for paediatric tonsillectomy*

Abstract

SummaryInvestigators from Bristol described a fentanyl-and diclofenac-based analgesic technique for tonsillectomy with low postoperative nausea and vomiting rates and low pain scores. This study compared the effectiveness of a modified Bristol technique with a codeine-based regimen with respect to PONV and analgesia. Sixty-five children, ASA 1-2, were randomly assigned to either the Bristol group (fentanyl 1-2 lg.kg )1 and diclofenac 1-2 mg.kg) or codeine group (codeine 1.5 mg.kg). All children received paracetamol 15 mg.kg )1 and dexamethasone 0.1 mg.kg. Postoperative nausea and vomiting and pain scores were recorded hourly, and fitness for discharge was assessed at 4 h. The overall incidence of postoperative nausea and vomiting was 21% with no difference between groups (Bristol group 8 ⁄ 30, codeine group 5 ⁄ 32, p = 0.29). Children in the Bristol group required analgesia earlier than those in the codeine group (p < 0.005), but maximum pain scores were not different (Bristol group median (IQR [range) 4.5 (3-5 [0-5]), codeine group 4.0 (2-5 [1-5]), p = 0.15). Twenty-three per cent of children were assessed as not fit for discharge at 4 h. The codeine-based regimen may have a small advantage over the Bristol regimen, but neither technique seems ideally suited for a day-case service without a longer period of observation.

Fracture of a GlideScope cobalt blade

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higher than 50 ml.h)1 ) using a 60-ml syringe and a syringe driver [1]. However, we could not find reports using volumetric infusion pump systems.

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“…We could find only one report of a GlideScope disposable blade fracture [1]. In that case, because of limited mouth opening, the blade was inserted into the right side of the mouth and oriented obliquely, rather than midline as is recommended.…”

Comparison of Cold Technique Tonsillectomy and Thermal Welding Tonsillectomy at Different Age Groups

“…In addition, restriction of the pharyngeal muscle activity due to pain leads to reduction in the clearance of tonsil bed and as a result of may cause infection and bleeding (Belloso et al, 2006). Local or systemic steroid administration, local anesthesia and analgesia applications besides new surgical techniques generating low heat and temperature take place in postoperative pain relief (Rawlinson et al, 2011). Surgical techniques and instruments often affect pain more than pharmacological agents.…”

Effect of cold-water cooling of tonsillar fossa and pharyngeal mucosa on post-tonsillectomy pain

“…A variety of methods have been attempted to reduce posttonsillectomy pain, including various surgical techniques, newly developed devices producing low heat and temperature, local or systemic steroid administration, local anesthetic blocks, and use of analgesics [9][10][11][12][13]. Generally, surgical techniques and devices influence postoperative pain more than pharmacologic intervention.…”