Painless tonsillectomy

The Children's Hospital, Denver, Colorado 80123, USA.
Current Opinion in Otolaryngology & Head and Neck Surgery (Impact Factor: 1.84). 01/2007; 14(6):369-74. DOI: 10.1097/MOO.0b013e32801042fa
Source: PubMed


Even though pediatric tonsillectomy is a well accepted treatment for upper airway obstruction or recurrent tonsillar infection, the painful recovery of this operation is unwelcome. As more studies are published on the beneficial effects of tonsillectomy, the number of tonsillectomies performed is likely to increase. It would behoove any surgeon performing this operation to be aware of the available options for post/perioperative pain control.
New techniques used to perform tonsillectomy, innovative adjuvant medical therapy and other tools are reviewed.
The search for 'the painless tonsillectomy' continues. Finding a technique that works best for each surgeon is paramount to successful tonsillectomy. Patient comfort, surgical time, complications such as bleeding and regrowth of tonsillar tissue, or recurrence of symptoms that lead to the initial operation should all be considered in the surgeon's choice of a particular tonsillectomy technique. Medical therapies such as corticosteroids in the perioperative period are well accepted as a pain adjuvant. Newer adjuvants include the use of pretonsillectomy injection of mixtures that include local anesthetics with opioids and clonidine. The use of nonsteroidal antiinflammatory drugs appears to be helpful for pain, but controversial regarding bleeding. Another successful strategy used to decrease pain perception is distraction.

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    ABSTRACT: Tonsillectomy is a very common surgical procedure performed worldwide. We retrospectively reviewed the data on tonsillectomy in the past 10 years from 1996 to 2006. There were a total of 329 children undergoing tonsillectomy. The median age was 6.8 years. Two hundred and sixty (79%) children received tonsillectomy for obstructive sleep apnoea, 69 (21%) for recurrent tonsillitis. The average operative time was 1 hour and 4 minutes. Intraoperative complication included 1 dislodged endotracheal tube during surgery while postoperative complication included 8 (2.4%) secondary haemorrhage. The average length of stay in hospital was 2.5 days. Majority of children resumed soft diet on day 2 after surgery. Tonsillectomy remains a safe and important operation in the field of Paediatric Otolaryngology.
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    ABSTRACT: Thesis (doctoral)--Linköping University, 2007.
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    ABSTRACT: To determine if placement of autologous platelet-rich plasma (PRP) on the tonsil beds at the time of tonsillectomy would decrease postoperative pain and complications. Double blind, randomized, prospective study. Seventy children were recruited to participate in the study, ranging in age from 4 to 15 years. They were randomized to treatment (PRP) or control groups. The parents, patients, and nurses were blinded as to which group they were in. Postoperative pain scores were obtained using the FACES pain scale and recorded in a home diary. Seventy patients were recruited to the study, and 12 did not submit their diaries and were considered to drop out of the study. Demographic data were similar for both control and treatment groups. Median pain scores, medication use, days to normal diet, and office visits did not differ between the two groups. PRP applied once at the time of tonsillectomy does not improve postoperative pain or recovery in pediatric patients.
    The Laryngoscope 08/2008; 118(10):1765-7. DOI:10.1097/MLG.0b013e31817f18e7 · 2.14 Impact Factor
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