Coblation tonsillectomy versus cold steel dissection tonsillectomy: a morphological study

AbstractObjectiveTo compare the extent of tissue damage produced by conventional cold steel and coblation tonsillectomy.MethodsTwenty patients underwent conventional and 18 underwent coblation tonsillectomy. The removed tonsils were histopathologically evaluated.ResultsAnalgesic use was lower in the coblation group during the early post-operative period. Histological investigation of tonsils removed by the conventional method showed intensive haemorrhage and hyperaemia in the tonsillar capsules, which was not seen in the coblation group. Furthermore, in the coblation group, there was less mast cell degranulation (p = 0.0081) and a smaller amount of skeletal muscle tissue (p = 0.0043) in the tonsillar capsules, indicating less tissue damage.ConclusionCompared to the cold steel technique, coblation tonsillectomy is superior in terms of less early post-operative pain and less damage to surrounding tissues. Significantly lower mast cell degranulation in coblation tonsillectomy may contribute to the reduction of post-operative pain.

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The relationship between the level of μ-opioid receptor (μORs) and postoperative analgesic use in patients undergoing septoplasty: a prospective randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-020-01138-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Muzaffer Gencer ◽

Ayşe Yeşim Göçmen

Keyword(s):

Opioid Receptor ◽

Recovery Room ◽

Control Group ◽

Analgesic Requirement ◽

Post Operative Period ◽

Post Operative Pain ◽

Analgesic Agents ◽

Vas Scores ◽

Μ Opioid Receptor ◽

Analgesic Use

Abstract Background In this study, the μ-Opioid receptor activity was assessed pre-operatively for its association with postoperative pain level and second analgesic requirement in patients undergoing septoplasty. Methods In our prospective study, 120 adult patients underwent septoplasty from June 2015 to January 2019 were randomly divided into 2 pre-operative groups. The first group (n = 60) was patients given tramadol (1–2 mg/kg) for post-operative analgesia, and the second group (control group) (n = 60) was initially prescribed only fentanyl (1 μg/ kg-i.v.) in the induction. Acetaminophen with codeine analgesic 325/30 mg (p.o.) was used as an rescue painkiller in the post-operative period. The μ-Opioid receptor activity was investigated in pre-operative blood samples and compared to post-operative pain level and time required for second round of analgesic administration. The visual analogue score (VAS) was used to evaluate the post-operative pain degree (0 no pain; 10 worst pain). The patients’ post-operative VAS scores were evaluated upon arrival to recovery room, and at the 1st, 3rd, 7th, 10th, and 24th hour post-operative period. Results Demographic data and peri-operative variables were similar in both study group (p < 0.05).There was no significant difference between the receptor levels in both groups and the mean receptor level was 200.94 ± 15.34 pg/mL (max:489.92 ± 22.36 pg/mL, min: 94.56 ± 11.23 pg/mL).In patients who used tramadol as the levels of μ-Opioid receptors increased, VAS scores of patients and second analgesic use decreased in post-operative period.The VAS scores in patients with higher receptor levels were lower in the recovery room (p < 0.05), 1st (p < 0.05) and 3rd hours (p < 0.05).The VAS scores were lower in the tramadol group compared to the control group (p < 0.05).Number of secondary analgesic requirement was significantly lower in patients of the tramadol group with higher receptor levels compared to the ones with lower receptor (p < 0.05) for arrival at the recovery room and 1st hour. Patients in the tramadol group needed a second pain killer much later than patients in the control group. Conclusions Our study demonstrates that patients with higher μOR levels have a higher efficacy of opioid analgesic agents and an lesser need for additional analgesic agents. Trial registration This trial was registered retrospectively (The ACTRN: ACTRN12619001652167, registration date: 26/11/2019).

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The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques

The Journal of Laryngology & Otology ◽

10.1017/s0022215117002328 ◽

2017 ◽

Vol 132 (3) ◽

pp. 240-245 ◽

Cited By ~ 10

Author(s):

D Wiltshire ◽

M Cronin ◽

N Lintern ◽

K Fraser-Kirk ◽

S Anderson ◽

...

Keyword(s):

Normal Activity ◽

Normal Diet ◽

Pain Level ◽

Single Institution ◽

Common Procedure ◽

Pain Scores ◽

Post Operative Period ◽

Post Operative Pain ◽

Single Blind ◽

Analgesic Use

AbstractObjectives:Tonsillectomy is a common procedure with significant post-operative pain. This study was designed to compare post-operative pain, returns to a normal diet and normal activity, and duration of regular analgesic use in Coblation and bipolar tonsillectomy patients.Methods:A total of 137 patients, aged 2–50 years, presenting to a single institution for tonsillectomy or adenotonsillectomy were recruited. Pain level, diet, analgesic use, return to normal activity and haemorrhage data were collected.Results:Coblation tonsillectomy was associated with significantly less pain than bipolar tonsillectomy on post-operative days 1 (p= 0.005), 2 (p= 0.006) and 3 (p= 0.010). Mean pain scores were also significantly lower in the Coblation group (p= 0.039). Coblation patients had a significantly faster return to normal activity than bipolar tonsillectomy patients (p< 0.001).Conclusion:Coblation tonsillectomy is a less painful technique compared to bipolar tonsillectomy in the immediate post-operative period and in the overall post-operative period. This allows a faster return to normal activity and decreased analgesic requirements.

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The relationship between the level of μ-opioid receptor (μORs) and postoperative analgesic use in patients undergoing septoplasty: A prospective randomized controlled trial.

10.21203/rs.3.rs-19493/v3 ◽

2020 ◽

Author(s):

MUZAFFER GENCER ◽

Ayşe Yeşim Göçmen

Keyword(s):

Opioid Receptor ◽

Recovery Room ◽

Control Group ◽

Analgesic Requirement ◽

Post Operative Period ◽

Post Operative Pain ◽

Analgesic Agents ◽

Vas Scores ◽

Μ Opioid Receptor ◽

Analgesic Use

Abstract Background: In this study, the μ-Opioid receptor activity was assessed pre-operatively for its association with postoperative pain level and second analgesic requirement in patients undergoing septoplasty. Methods: In our prospective study, 120 adult patients underwent septoplasty from June 2015 to January 2019 were randomly divided into 2 pre-operative groups. The first group (n=60) was patients given tramadol (1-2 mg/kg) for post-operative analgesia, and the second group (control group) (n=60) was initially prescribed only fentanyl (1 µg/ kg-i.v.) in the induction. Acetaminophen with codeine analgesic 325/30 mg (p.o.) was used as an rescue painkiller in the post-operative period. The μ-Opioid receptor activity was investigated in pre-operative blood samples and compared to post-operative pain level and time required for second round of analgesic administration. The visual analogue score (VAS) was used to evaluate the post-operative pain degree (0 no pain; 10 worst pain). The patients’ post-operative VAS scores were evaluated upon arrival to recovery room, and at the 1st, 3rd, 7th, 10th, and 24th hour post-operative period. Results: Demographic data and peri-operative variables was similar in both study group (p<0.05).There was no significant difference between the receptor levels in both groups and the mean receptor level was 200.94±15.34 pg/Ml (max:489.92±22.36 pg/mL, min: 94.56±11.23 pg/mL).In patients who used tramadol as the levels of μ-Opioid receptors increased, VAS scores of patients and second analgesic use decreased in post-operative period.The VAS scores in patients with higher receptor levels were lower in the recovery room, (p<0.05), 1st (p<0.05) and 3rd hours (p<0.05).The VAS scores were lower in the tramadol group compared to the control group p <0.05.Number of secondary analgesic requirement was significantly lower in patients of the tramadol group with higher receptor levels compared to the ones with lower receptor (p<0.05) for arrival at the recovery room and 1st hour.Patients in the tramadol group needed a second pain killer much later than patients in the control group.Conclusions: Our study demonstrates that patients with higher μOR levels have a higher efficacy of opioid analgesic agents and an lesser need for additional analgesic agents. Trial registration:This trial was registered retrospectively (The ACTRN: ACTRN12619001652167, registration date: 26/11/2019).

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Mast cell degranulation and de novo histamine formation contribute to sustained postexercise vasodilation in humans

Journal of Applied Physiology ◽

10.1152/japplphysiol.00633.2016 ◽

2017 ◽

Vol 122 (3) ◽

pp. 603-610 ◽

Cited By ~ 11

Author(s):

Steven A. Romero ◽

Jennifer L. McCord ◽

Matthew R. Ely ◽

Dylan C. Sieck ◽

Tahisha M. Buck ◽

...

Keyword(s):

Skeletal Muscle ◽

Blood Flow ◽

Mast Cell ◽

Aerobic Exercise ◽

Histidine Decarboxylase ◽

De Novo ◽

Vastus Lateralis ◽

Muscle Blood Flow ◽

Mast Cell Degranulation ◽

Local Blood Flow

In humans, acute aerobic exercise elicits a sustained postexercise vasodilation within previously active skeletal muscle. This response is dependent on activation of histamine H1and H2receptors, but the source of intramuscular histamine remains unclear. We tested the hypothesis that interstitial histamine in skeletal muscle would be increased with exercise and would be dependent on de novo formation via the inducible enzyme histidine decarboxylase and/or mast cell degranulation. Subjects performed 1 h of unilateral dynamic knee-extension exercise or sham (seated rest). We measured the interstitial histamine concentration and local blood flow (ethanol washout) via skeletal muscle microdialysis of the vastus lateralis. In some probes, we infused either α-fluoromethylhistidine hydrochloride (α-FMH), a potent inhibitor of histidine decarboxylase, or histamine H1/H2-receptor blockers. We also measured interstitial tryptase concentrations, a biomarker of mast cell degranulation. Compared with preexercise, histamine was increased after exercise by a change (Δ) of 4.2 ± 1.8 ng/ml ( P < 0.05), but not when α-FMH was administered (Δ−0.3 ± 1.3 ng/ml, P = 0.9). Likewise, local blood flow after exercise was reduced to preexercise levels by both α-FMH and H1/H2blockade. In addition, tryptase was elevated during exercise by Δ6.8 ± 1.1 ng/ml ( P < 0.05). Taken together, these data suggest that interstitial histamine in skeletal muscle increases with exercise and results from both de novo formation and mast cell degranulation. This suggests that exercise produces an anaphylactoid signal, which affects recovery, and may influence skeletal muscle blood flow during exercise.NEW & NOTEWORTHY Blood flow to previously active skeletal muscle remains elevated following an acute bout of aerobic exercise and is dependent on activation of histamine H1and H2receptors. The intramuscular source of histamine that drives this response to exercise has not been identified. Using intramuscular microdialysis in exercising humans, we show both mast cell degranulation and formation of histamine by histidine decarboxylase contributes to the histamine-mediated vasodilation that occurs following a bout of aerobic exercise.

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The effect of local passive heating on skeletal muscle histamine concentration: Implications for exercise-induced histamine release

Journal of Applied Physiology ◽

10.1152/japplphysiol.00740.2021 ◽

2021 ◽

Author(s):

Joshua E. Mangum ◽

Karen Wiedenfeld Needham ◽

Dylan C. Sieck ◽

Matthew R. Ely ◽

Emily A. Larson ◽

...

Keyword(s):

Skeletal Muscle ◽

Mast Cell ◽

Mast Cells ◽

Histidine Decarboxylase ◽

Mast Cell Degranulation ◽

Muscle Temperature ◽

Passive Heating ◽

Histamine Concentration ◽

Histamine Formation ◽

Histamine Response

Aerobic exercise induces mast cell degranulation and increases histamine formation by histidine decarboxylase, resulting in an ~150% increase in intramuscular histamine. The purpose of this study was to determine if the increase in skeletal muscle temperature associated with exercise is sufficient to explain this histamine response. Specifically, we hypothesized that local passive heating that mimics the magnitude and time-course of changes in skeletal muscle temperature observed during exercise would result in increased intramuscular histamine concentrations comparable to exercising values. Seven subjects participated in the main study in which pulsed short-wave diathermy was used to passively raise the temperature of the vastus lateralis over 60 min. Heating increased intramuscular temperature from 32.6 (95% CI 32.0 to 33.2) to 38.9 (38.7 to 39.2) oC (P < 0.05) and increased intramuscular histamine concentration from 2.14 (1.92 to 2.36) to 2.97 (2.57 to 3.36) ng/ml (P < 0.05), an increase of 41%. In a follow-up in vitro experiment utilizing human-derived cultured mast cells, heating to comparable temperatures did not activate mast cell degranulation. Therefore, it appears that exercise-associated changes in skeletal muscle temperature are sufficient to generate elevations in intramuscular histamine concentration. However, this thermal effect is most likely due to changes in de novo histamine formation via histidine decarboxylase and not due to degranulation of mast cells. In conclusion, physiologically relevant increases in skeletal muscle temperature explain part, but not all, of the histamine response to aerobic exercise. This thermal effect may be important in generating the positive adaptations to exercise training.

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The relationship between the level of μ-opioid receptor (μORs) and postoperative analgesic use in patients undergoing septoplasty: A prospective randomized controlled trial.

10.21203/rs.3.rs-19493/v4 ◽

2020 ◽

Author(s):

MUZAFFER GENCER ◽

Ayşe Yeşim Göçmen

Keyword(s):

Opioid Receptor ◽

Recovery Room ◽

Control Group ◽

Analgesic Requirement ◽

Post Operative Period ◽

Post Operative Pain ◽

Analgesic Agents ◽

Vas Scores ◽

Μ Opioid Receptor ◽

Analgesic Use

Abstract Background: In this study, the μ-Opioid receptor activity was assessed pre-operatively for its association with postoperative pain level and second analgesic requirement in patients undergoing septoplasty.Methods: In our prospective study, 120 adult patients underwent septoplasty from June 2015 to January 2019 were randomly divided into 2 pre-operative groups. The first group (n=60) was patients given tramadol (1-2 mg/kg) for post-operative analgesia, and the second group (control group) (n=60) was initially prescribed only fentanyl (1 µg/ kg-i.v.) in the induction. Acetaminophen with codeine analgesic 325/30 mg (p.o.) was used as an rescue painkiller in the post-operative period. The μ-Opioid receptor activity was investigated in pre-operative blood samples and compared to post-operative pain level and time required for second round of analgesic administration. The visual analogue score (VAS) was used to evaluate the post-operative pain degree (0 no pain; 10 worst pain). The patients’ post-operative VAS scores were evaluated upon arrival to recovery room, and at the 1st, 3rd, 7th, 10th, and 24th hour post-operative period.Results: Demographic data and peri-operative variables were similar in both study group (p<0.05).There was no significant difference between the receptor levels in both groups and the mean receptor level was 200.94±15.34 pg/mL (max:489.92±22.36 pg/mL, min: 94.56±11.23 pg/mL).In patients who used tramadol as the levels of μ-Opioid receptors increased, VAS scores of patients and second analgesic use decreased in post-operative period.The VAS scores in patients with higher receptor levels were lower in the recovery room (p<0.05), 1st (p<0.05) and 3rd hours (p<0.05).The VAS scores were lower in the tramadol group compared to the control group (p<0.05).Number of secondary analgesic requirement was significantly lower in patients of the tramadol group with higher receptor levels compared to the ones with lower receptor (p<0.05) for arrival at the recovery room and 1st hour.Patients in the tramadol group needed a second pain killer much later than patients in the control group.Conclusions: Our study demonstrates that patients with higher μOR levels have a higher efficacy of opioid analgesic agents and an lesser need for additional analgesic agents.Trial registration:This trial was registered retrospectively (The ACTRN: ACTRN12619001652167, registration date: 26/11/2019).

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The relationship between the level of μ -opioid receptor (μORs) and postoperative analgesic use in patients undergoing septoplasty: A prospective randomized controlled trial.

10.21203/rs.3.rs-19493/v5 ◽

2020 ◽

Author(s):

MUZAFFER GENCER ◽

Ayşe Yeşim Göçmen

Keyword(s):

Opioid Receptor ◽

Recovery Room ◽

Control Group ◽

Analgesic Requirement ◽

Post Operative Period ◽

Post Operative Pain ◽

Analgesic Agents ◽

Vas Scores ◽

Μ Opioid Receptor ◽

Analgesic Use

Abstract Background : In this study, the μ-Opioid receptor activity was assessed pre-operatively for its association with postoperative pain level and second analgesic requirement in patients undergoing septoplasty. Methods : In our prospective study,120 adult patients underwent septoplasty from June 2015 to January 2019 were randomly divided into 2 pre-operative groups. The first group (n=60) was patients given tramadol (1-2 mg/kg) for post-operative analgesia, and the second group (control group)(n=60) was initially prescribed only fentanyl (1 µg/ kg-i.v.) in the induction. Acetaminophen with codeine analgesic 325/30 mg (p.o.) was used as an rescue painkiller in the post-operative period. The μ-Opioid receptor activity was investigated in pre-operative blood samples and compared to post-operative pain level and time required for second round of analgesic administration. The visual analogue score (VAS) was used to evaluate the post-operative pain degree (0 no pain; 10 worst pain). The patients’ post-operative VAS scores were evaluated upon arrival to recovery room, and at the 1st, 3rd, 7th, 10th, and 24 th hour post-operative period. Results: Demographic data and peri-operative variables were similar in both study group (p<0.05).There was no significant difference between the receptor levels in both groups and the mean receptor level was 200.94±15.34 pg/mL (max:489.92±22.36 pg/mL, min:94.56±11.23 pg/mL).In patients who used tramadol as the levels of μ-Opioid receptors increased, VAS scores of patients and second analgesic use decreased in post-operative period.The VAS scores in patients with higher receptor levels were lower in the recovery room (p<0.05), 1st (p<0.05) and 3rd hours (p<0.05).The VAS scores were lower in the tramadol group compared to the control group (p<0.05).Number of secondary analgesic requirement was significantly lower in patients of the tramadol group with higher receptor levels compared to the ones with lower receptor (p<0.05) for arrival at the recovery room and 1 st hour.Patients in the tramadol group needed a second pain killer much later than patients in the control group.Conclusions: Our study demonstrates that patients with higher μOR levels have a higher efficacy of opioid analgesic agents and an lesser need for additional analgesic agents. Trial registration: This trial was registered retrospectively (The ACTRN: ACTRN12619001652167, registration date:26/11/2019).

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