Pain after discharge following head and neck surgery in children

Wilson, Caroline A.; Sommerfield, David; Drake‐Brockman, Thomas F. E.; Bieberstein, Lita von; Ramgolam, Anoop; Ungern‐Sternberg, Britta S. von

doi:10.1111/pan.12974

Cited by 29 publications

(32 citation statements)

References 29 publications

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“…Our research has also shown branches passing onto the lingual frenulum, confirming that the frenulum is indeed sensate. Pain requiring treatment with analgesia has been reported as long as 13 days following frenotomy (Wilson et al, ). The experience of postfrenotomy pain is likely to vary considerably between individuals, influenced by many factors including depth and size of the wound and the frequency and nature of any postprocedure wound interventions.…”

Section: Discussionmentioning

confidence: 99%

Defining the anatomy of the neonatal lingual frenulum

et al. 2019

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The lingual frenulum is recognized as having the potential to limit tongue mobility, which may lead to difficulties with breastfeeding in some infants. There is extensive variation between individuals in the appearance of the lingual frenulum but an ambiguous relationship between frenulum appearance and functional limitation. An increasing number of infants are being diagnosed with ankyloglossia, with growing uncertainty regarding what can be considered "normal" lingual frenulum anatomy. In this study, microdissection of four fresh tissue premature infant cadavers shows that the lingual frenulum is a dynamic, layered structure formed by oral mucosa and the underlying floor of mouth fascia, which is mobilized into a midline fold with tongue elevation and/or retraction. Genioglossus is suspended from the floor of mouth fascia, and in some individuals can be drawn up into the fold of the frenulum. Branches of the lingual nerve are located superficially on the ventral surface of the tongue, immediately beneath the fascia, making them vulnerable to injury during frenotomy procedures. This research challenges the longstanding belief that the lingual frenulum is a midline structure formed by a submucosal "band" or "string" and confirms that the neonatal lingual frenulum structure replicates that recently described in the adult. This article provides an anatomical construct for understanding and describing variability in lingual frenulum morphology and lays the foundation for future research to assess the impact of specific anatomic variants of lingual frenulum morphology on tongue mobility. Clin. Anat. 32:824-835, 2019.

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Section: Discussionmentioning

confidence: 99%

Defining the anatomy of the neonatal lingual frenulum

et al. 2019

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“…In small children, rectal approach could be considered as well as oral paracetamol as a part of premedication (preemptive analgesia). 61,186 • Loading dose of tramadol or other suitable agent if available: nalbuphine, piritramide before the end of anesthesia.…”

Section: Intraoperative Postoperativementioning

confidence: 99%

“…• Intravenous paracetamol in immediate postoperative period or • Metamizole in divided doses. 186 • Oral NSAIDs and/or paracetamol in adequate dosage during the entire postoperative period from the moment when the oral intake is possible • Intravenous or oral tramadol or other suitable agent if available: nalbuphine, piritramide as rescue in the ward. • Consider iv-PCA including adequate monitoring 62,187 VITTINGHOFF ET AL.…”

Section: Intraoperative Postoperativementioning

confidence: 99%

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Vittinghoff

Lönnqvist

Mossetti

et al. 2018

Pediatric Anesthesia

123

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The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice.

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“…Postoperative pain associated with myringotomy is rarely severe, with most children reporting mild-to-moderate pain scores 47. Higher pain scores may be associated with bilateral or repeat procedures.…”

Section: Discharge From Ambulatory Carementioning

confidence: 99%

Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

Robinson

Engelhardt

2017

LRA

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PurposeMyringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findingsThis review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED) and emergence agitation (EA). New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed.SummaryLong-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6–4–0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up.

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Pain after discharge following head and neck surgery in children

Cited by 29 publications

References 29 publications

Defining the anatomy of the neonatal lingual frenulum

Defining the anatomy of the neonatal lingual frenulum

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

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