Can mucosal sealing reduce tonsillectomy pain?
Introduction
Although tonsillectomy is the most frequent operation performed on the pediatric population, postoperative pain relief is still a problem for the patients, families and surgeons. Especially in the first 3 days after the operation, pain is a significant problem [1]. There are various analgesic medications for pain management, the spectrum of which varies from acetaminophen to narcotic analgesics each with their own advantages and disadvantages. Sometimes acetaminophen can be ineffective for pain control and a need may arise for the use of non-steroid anti-inflammatory drugs although they carry the risk of increasing bleeding time and lead to the most feared complication of tonsillectomy: the postoperative bleeding. Besides postoperative medication, various surgical techniques can be used for pain control. Some of these techniques are as follows: classical cold knife dissection, hot knife, laser assisted tonsillectomy, using powered instruments, the coblation method and fibrin sealing the operation site [2], [3], [4], [5], [6]. But there are controversial arguments about their effectiveness on the postoperative pain control.
The pain is a protective mechanism of the body which alerts the organism to get rid of the stimulus that causes it. It is a significant indicator that measures the postoperative comfort of the patients. But the reliability of pain assessment is questionable for its tendency of subjective perception. The methods used for pain assessment are visual analog scales, numeric pain intensity scales, simple descriptive pain intensity scales, graphic rating scales, verbal rating scales, pain faces scales, numeric pain intensity and pain distress scales, brief pain inventories, and memorial pain assessment cards [7]. Understanding the extent of the pain suffered by the patients is crucial for the physicians to come up with an appropriate decision to relieve the pain. Pain assessment and pain management are becoming more important issues in today's modern medicine and are used as important indicators for many accreditation programs under total quality management applications of the hospitals.
The aim of this paper is to search for the effectiveness of a surgical method over the pain after tonsillectomy operations in pediatric patients. The surgical method is modified slightly. Once the method is found to be effective in pain management, this will lead to less hospital day stays, less medication for pain control, shorter recovery period and as a result more parent satisfaction from the operation.
Section snippets
Materials and methods
The study had been performed between 2001 and 2004. Thirty-nine patients between 3 and 15 years old were enrolled into the study. Parental informed consents were obtained. Children under 3 years of age were excluded because of difficulty with reliable participation in the pain questionnaire. Each patient has either tonsillectomy because of chronic tonsillitis, or adenoidectomy with tonsillectomy because of adenotonsillar hypertrophy with chronic infection, or adenoidectomy with tonsillectomy
Results
The age range of patients is between 3 and 15 with a mean of 6.98 years. There are 22 (56.4%) male and 17 (43.6%) female patients. Posterior tonsil pillar mucosa is laid over the tonsillectomy site at 14 (35.9%) right and 25 (64.1%) left sides. All of the attending surgeons were right handed and it was easier for them to suture the left side and this makes the difference between the percentages of the right and left sides. For the overall cases the average time for suturing the mucosa over the
Discussion
Pain assessment after tonsillectomy operations must be included in the routine post-tonsillectomy physical assessment of the patients. The intense pain itself can have adverse effect both on the heart rate and blood pressure of the patient. The pain which the body senses acting via the sympathetic autonomous nervous system may increase the heart rate, and the blood pressure. Both of these effects causes a high cardiac output and thus leads to postoperative exhaustion of the patient. In addition
Conclusion
Tonsillectomy is the most frequently performed operation on the children and still it causes significant pain for the child. There are various methods in surgical techniques and different classes of medications to overcome the pain problem. But none of them could able to completely cease the pain perception after the operation. Combination of them can help the suffering child and differences in surgical techniques can be an adjunctive to the analgesics. The surgical method of sealing the
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