scholarly journals Postoperative Pain and 14-Day Recovery in Children Undergoing Adenotonsillectomy: Low Thermal Damage Device Versus Electrosurgery

2019 ◽  
Vol 98 (4) ◽  
pp. E1-E7 ◽  
Author(s):  
Kathryn V. Blake ◽  
Jobayer Hossain ◽  
Brett Chafin ◽  
Angela Black ◽  
Stefanie Schrum ◽  
...  
Keyword(s):  
Sleep Disordered Breathing ◽  
Thermal Damage ◽  
Controlled Trial ◽  
Median Number ◽  
Pain Scale ◽  
Pain Medication ◽  
Adenotonsillar Hypertrophy ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Obstructive Sleep

This was a randomized controlled trial of low thermal damage device versus traditional electrosurgery in children 3 to 17 years old with a clinical diagnosis of sleep disordered breathing, obstructive sleep apnea with adenotonsillar hypertrophy, or recurrent adenotonsillitis. Pain score (Wong-Baker FACES pain scale) was recorded each morning before eating, drinking, or administering pain medication for 14 days postoperatively. Seventy-five children were enrolled. There was no difference in the rate of decrease in pain scores. A significant interaction between rate of pain decrease and number of pain medication doses was present ( P < .0001). Median number of pain medication doses was greater with electrosurgery (36, range: 7-49) versus low thermal device (21, range: 2-124; P = .001). Pain scores reached 0 after a median of 7 days (95% confidence interval [CI], 5.2-8.6) for low thermal device and 9 days (95% CI, 8.0-10.0) for electrosurgery ( P = .67). One child randomized to electrosurgery was withdrawn due to hospitalization for postoperative bleed. In children, low thermal device results in significantly less pain medication used during the postoperative period than electrosurgery.

scholarly journals Effects of an individualized analgesia protocol on the need for medical interventions after adenotonsillectomy in children: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jian Guo ◽  
Peijun Zhuang ◽  
Kun Liu ◽  
Yuanyuan Wan ◽  
Xuan Wang
Keyword(s):  
Median Duration ◽  
Controlled Trial ◽  
Pain Scale ◽  
Medical Intervention ◽  
Secondary Outcome ◽  
Sleep Study ◽  
Medical Interventions ◽  
Randomized Controlled ◽  
Obstructive Sleep ◽  
Blinded Trial

Abstract Background It has been proposed that the dose of rescue opioids should be individually titrated to the severity of obstructive sleep apnea after adenotonsillectomy. However, a sleep study is not always available before adenotonsillectomy. This randomized, controlled and blinded trial evaluated a strategy of pain control individualized to the results of a fentanyl test, rather than the results of polysomnography, in children after adenotonsillectomy. Methods A total of 280 children (3–10 years old) undergoing elective adenotonsillectomy were randomized into an individualized protocol (IP) group or a conservative protocol (CP) group. All patients received a fentanyl test before extubation. Pain was assessed every 10 min in the recovery room, and rescue morphine was given when the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) score was > 6. In the IP group, the dose of rescue morphine was individualized to the results of the fentanyl test (10 μg/kg in the case of a positive result and 50 μg/kg in the case of a negative result). In the CP group, the dose was fixed (25 μg/kg). The primary outcome was the percentage of patients requiring at least one medical intervention. The secondary outcome was the median duration of CHEOPS scores > 6. Results Fewer patients in the IP group than in the CP group required medical interventions [11.9% (16/134) vs 22.3% (29/130), P = 0.025]. The median duration of CHEOPS scores > 6 was shorter in the IP group than in the CP group [20 (95% CI: 17 to 23) min vs 30 (95% CI: 28 to 32) min, P <  0.001]. Conclusions Compared with a conservative dosing approach, this individualized protocol may improve analgesia without a significant increase in respiratory adverse events. Trial registration ClinicalTrials.gov NCT02990910, registered on 13/12/2016.

Relief of Procedural Pain in Critically Ill Patients by Music Therapy: A Randomized Controlled Trial

2019 ◽  
Vol 26 (3) ◽  
pp. 156-165 ◽  
Author(s):  
Yeşim Yaman Aktaş ◽  
Neziha Karabulut
Keyword(s):  
Mechanical Ventilation ◽  
Music Therapy ◽  
Controlled Trial ◽  
Pain Scale ◽  
Procedural Pain ◽  
Control Group ◽  
Endotracheal Suctioning ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Behavioral Pain Scale

Background: This study aimed to determine the effectiveness of music listening for procedural pain relief using two different observational pain tools during endotracheal suctioning. Materials and Methods: This study was a randomized controlled trial. The sample of the study included 98 patients with mechanical ventilation support who met the selection criteria. The patients were randomly assigned to control and music therapy groups. Patients in the control group were routinely suctioned as usual. Patients in the music group received music therapy 20 min before, during, and 20 min after endotracheal suctioning. The primary outcome was the pain relief during suctioning. Results: Forty patients in each arm completed the study. Pain scores in the Critical Care Pain Observation Tool and Behavioral Pain Scale were lower in the music group than in the control group during endotracheal suctioning (group: F = 14.85, p = 0.000; F = 9.04, p = 0.000, respectively). It was also found to be a significant interaction effect between the groups and time (group × time: F = 17.35, p = 0.000; F = 18.00, p = 0.000, respectively). Conclusion: The Critical Care Pain Observation Tool and Behavioral Pain Scale in the current study generally demonstrated similar pain scores during the painful procedure. Our findings support that music therapy may act as a nonpharmacological therapy to relieve procedural pain in patients on mechanical ventilation.

scholarly journals The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular rethognathia: a study protocol for a multicenter randomized controlled trial

2020 ◽  
Author(s):  
Yuanyuan Li ◽  
Jiali Wu ◽  
Jinghan Guo ◽  
Liming Yu ◽  
Jing Wang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Treatment Group ◽  
Orthodontic Treatment ◽  
Controlled Trial ◽  
Treatment Approaches ◽  
Adenotonsillar Hypertrophy ◽  
Randomized Controlled ◽  
Obstructive Sleep ◽  
Starting Point ◽  
Multicenter Randomized Controlled Trial

Abstract Background: Pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) is a multifactorial syndrome caused by many risk factors, such as craniofacial anomalies, adenotonsillar hypertrophy, obesity and airway inflammation. Although new treatment patterns have been recently proposed, treatment methods for children have continued to be particularly challenging and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment for mild OSAHS children with mandibular rethognathia.Methods: A sample of 352 children with mild OSAHS and mandibular rethognathia, aged between 7 and 10 years, will be enrolled in the study. They will be randomized into four groups – the drug treatment group, or the surgical treatment group, or the orthodontic treatment group, or the surgery and postoperative orthodontic group. After randomization they will receive treatments within 4 weeks. Outcome assessment will take place at points: (1) at baseline, (2) 7 months after the treatment starting point, (3) 12 months after the treatment starting point, (3) 24 months after the treatment starting point. The primary endpoint of the trial is the mean change of obstructive apnea/hypopnea index. Other endpoints will consist of the lowest oxygen saturation, apnea index, and hypopnea index assessed by polysomnogram, subjective symptoms (assessed by questionnaire OSA-20), cephalometric measurements and Morphologic analysis of upper airway.Discussion: The results of this study will provide valuable evidence for merits and long-term efficacy of different treatment approaches and contribute to facilitate the multidisciplinary treatment of pediatric OSAHS.Trial registration: Clinicaltrials.gov, ID: NCT03451318. Registered on 2 March 2018 (last update posted 19 April 2018).

scholarly journals The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular rethognathia: a study protocol for a multicenter randomized controlled trial

2020 ◽  
Author(s):  
Yuanyuan Li ◽  
Jiali Wu ◽  
Jinghan Guo ◽  
Liming Yu ◽  
Jing Wang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Treatment Group ◽  
Orthodontic Treatment ◽  
Controlled Trial ◽  
Treatment Approaches ◽  
Adenotonsillar Hypertrophy ◽  
Randomized Controlled ◽  
Obstructive Sleep ◽  
Starting Point ◽  
Multicenter Randomized Controlled Trial

Abstract Background: Pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) is a multifactorial syndrome caused by many risk factors, such as craniofacial anomalies, adenotonsillar hypertrophy, obesity and airway inflammation. Although new treatment patterns have recently been proposed, treatment methods for children remain particularly challenging and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment for mild OSAHS children with mandibular rethognathia.Methods: A sample of 352 children with mild OSAHS and mandibular rethognathia, aged between 7 and 10 years, will be enrolled in the study. They will be randomized into four groups – the drug treatment group, the surgical treatment group,the orthodontic treatment group, or the surgery and postoperative orthodontic group. After randomization they will receive treatments within 4 weeks. Outcome assessment will take place at the following points: (1)baseline, (2) 7 months after the treatment starting point, (3) 12 months after the treatment starting point, and (3) 24 months after the treatment starting point. The primary endpoint of the trial is the mean change of obstructive apnea/hypopnea index. Other endpoints will consist of the lowest oxygen saturation, apnea index, and hypopnea index assessed by polysomnogram, subjective symptoms (assessed by the OSA-20 questionnaire), cephalometric measurements and morphologic analysis of the upper airway.Discussion: The results of this study will provide valuable evidence for the merits and long-term efficacy of different treatment approaches and contribute to facilitating the multidisciplinary treatment of pediatric OSAHS.Trial registration: Clinicaltrials.gov, ID: NCT03451318. Registered on 2 March 2018 (last update posted 19 April 2018).

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