ORIGINAL ARTICLES   

Otorinolaringologia 2010 December;60(4):239-43

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

An assessment of postoperative pain in patients undergoing tonsillectomy

Chaturvedi J., Vamanshankar H.,Chandrashekar S, Manikantan K., Nayar R. C.

Department of Otolaryngology Head and Neck Surgery, St John’s Medical College Hospital, John Nagar, Koramangala, Bangalore, India

Aim. The aim of this study was to identify and assess the relative effect of various factors responsible for postoperative pain in patients after tonsillectomy.
Methods. Fifty patients aged between 3 and 70 years, who were scheduled for tonsillectomy, in the ORL department of a tertiary referral hospital, were enrolled for this study. Informed consent was obtained before hand, and patients were chosen consecutively. Pre-, intra- and postoperative parameters such as use of analgesics, duration of surgery, amount of blood loss, use of ligatures, cautery etc. were recorded. Surgeons were questioned regarding possible factors which influenced the level of postoperative pain. Patients were explained about the Wong Baker’s Visual Analogue Pain scale prior to surgery, and then tested in the postoperative period at 1 hour, 24 hour and 48 hour time intervals. The degree of pain was correlated to the parameters recorded. Institutional Ethical Review Board permission was granted for the study.
Results. The results concerning 50 patients (mean age of 13.5 years) over a six-month period showed the mean Visual Analogue Score at 1 hour after surgery was 7/10, at 24 hours was 6/10 and at 48 hours was 3.5/10. Factors such as age, sex, preoperative education, pre- and postoperative antibiotics, pre- and postoperative analgesics, grade of tonsillitis, experience of surgeon and method of surgical dissection did not affect the degree of postoperative pain significantly. However, the use of ligatures, cautery and increased amount of blood loss during surgery lead to increase in postoperative pain levels (P<0.05). Shorter duration of surgery, early and frequent oral intake of cold/bland diet in the postoperative period reduced the postoperative pain significantly (P<0.05).
Conclusion. The use of ligatures, cautery and increased amount of blood loss during surgery lead to increase in postoperative pain levels (P<0.05). Shorter duration of surgery, early and frequent oral intake in the postoperative period reduced the postoperative pain significantly (P<0.05).