Universität zu Köln

Gostian, Antoniu-Oreste, Loeser, Johannes, Tholen, Christian, Wolber, Philipp, Otte, Martin, Schwarz, David, Heindl, Ludwig Maximilian, Balk, Matthias and Gostian, Magdalena (2020). Postoperative pain after tonsillectomy - the value of standardized analgesic treatment protocols. Auris Nasus Larynx, 47 (6). S. 1009 - 1018. OXFORD: ELSEVIER SCI LTD. ISSN 1879-1476

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Abstract

Objective: To alleviate pain after tonsillectomy (TE) with escalating gradual treatment protocols in a prospective trial. Materials & Methods: Following TE, 83 consecutive adult patients were treated with two different four-staged escalating analgesic protocols. Metamizole served as basic medication in protocol 1 (PT1; n = 44), whereas with protocol 2 (PT2; n = 39) ibuprofen was applied as baseline analgesic. Both protocols were escalated according to the patient's needs to metamizole and ibuprofen vice versa and additional weak to strong opioids. The primary efficacy endpoint was defined as the minimum and maximum pain as well as pain on ambulation (NRS, 0-10). Secondary endpoints comprised analgesic score, patient satisfaction and treatment-related side-effects. Results: Both patient groups exhibited similar demographic characteristics (PT1: empty set 28.8 years; 64% female and PT2: empty set 26.6 years; 56% female). Maximum pain (6.7 +/- 1.9 vs. 7.6 +/- 1.6, t((81)) = -2.254, p = 0.027) and pain on ambulation (5.0 +/- 1.8 vs. 5.8 +/- 1.8, t((81)) = -2.114, p = 0.038) were significantly higher with PT2. 68.2% of patients with PT1 needed an escalation of analgesic treatment compared to 100% with PT2 (p < 0.001). The opioid consumption was also significantly higher with PT2 (43.2% vs. 71.8%, p < 0.001). There were no significant differences regarding functional impairments, side-effects and patient satisfaction (7.0 +/- 2.0 vs. 7.4 +/- 2.4, t((79)) = -0.897, p = 0.373). Conclusion: Both treatment protocols yielded in a high degree of patient satisfaction but dis-satisfactory pain relief following TE. Metamizole can be recommended as a basic medication allowing for improved pain relief. Reported pain intensities were independent of the amount of opioid intake. Further research is mandatory to standardize and improve analgesic treatment after TE. (C) 2020 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gostian, Antoniu-Oreste UNSPECIFIED UNSPECIFIED UNSPECIFIED Loeser, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Tholen, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Wolber, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Otte, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Schwarz, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Heindl, Ludwig Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Balk, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Gostian, Magdalena UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-309550
DOI:	10.1016/j.anl.2020.05.011
Journal or Publication Title:	Auris Nasus Larynx
Volume:	47
Number:	6
Page Range:	S. 1009 - 1018
Date:	2020
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1879-1476
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language OTO-RHINO-LARYNGOLOGY; QUALITY IMPROVEMENT; INTERNATIONAL PAIN; DOUBLE-BLIND; MANAGEMENT; SURGERY; SATISFACTION; GUIDELINES; CHILDREN; RISK Multiple languages Otorhinolaryngology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/30955