The application of xylocaine 10% pump-spray to improve immediate post-adenotonsillectomy pain in children : a randomized controlled trial

dc.contributor.authorOpperman, Jacobus B.
dc.contributor.authorTshifularo, Mashudu
dc.date.accessioned2023-08-16T08:08:35Z
dc.date.available2023-08-16T08:08:35Z
dc.date.issued2022-10
dc.description.abstractINTRODUCTION : Post-adenotonsillectomy pain is often severe, requiring substantial analgesia in the first 48–72 h. This pain is not only distressing to the patient and his or her parents, but often reflects poorly on an otherwise well performed procedure. Safe, simple and effective post-adenotonsillectomy pain control is still clinically elusive, even though a multitude of surgical and analgesic interventions have been proposed. OBJECTIVES : To investigate the analgesic properties of immediate post-operative application of xylocaine 10% pump spray to the tonsillar fossae in children having undergone adenotonsillectomy and how this impacts on anesthetic emergence and pain control in the first 24-h. METHODS : In this double-blinded, randomized, placebo-controlled trial, 80 children were stratified into two groups: Group I (3-8 years-old) and Group II (9–14 years-old). Within these groups, participants were randomized to receive either xylocaine 10% pump spray or normal saline 0.9% post-operatively. A standardized anesthetic/analgesic regime was used intra-operatively. The same surgeon performed all surgeries using bi-polar diathermy. Outcome variables included state of anesthetic emergence; pain scores at specific intervals; need for rescue analgesia; post-operative nausea and vomiting; time to first oral intake and comfort associated with initial oral intake. RESULTS : Xylocaine 10% pump spray consistently provided superior pain control at all time intervals compared to normal saline 0.9% (p = 0.011). This was most pronounced in children 3–8 years old (Group I). Xylocaine 10% pump spray and normal saline 0.9% provided similar pain relief in children 9–14 years old (Group (II) (p = 0.640). Children receiving xylocaine had a decreased incidence of emergence delirium and consistently required less rescue analgesia (p = 0.005). Children who received xylocaine did not eat sooner post-operatively, but they experienced less pain when ingesting liquids (p = 0.003) and solids (p = 0.000). Children who received xylocaine did not experience increased post-operative complications (p = 1.000) or nausea and vomiting (p = 0.153). CONCLUSION : Xylocaine 10% spray may serve as a valuable adjunct to effective pain control post-adenotonsillectomy, especially if long acting opioids are contraindicated, as with patients with obstructive sleep apnea. The benefit of xylocaine appears to be negligible when a long acting opioid is administered. The benefits of xylocaine were most noteworthy in children aged 3–8 years old. This is the largest trial (n = 80) to date to assess the efficacy of xylocaine spray in isolation post-adenotonsillectomy. Xylocaine also offers improved comfort with oral intake and decreases emergence delirium and need for rescue analgesia without any increase in post-operative complications. Local anesthesia may decrease costs and help to solve the conundrum of a painless adenotonsillectomy especially in resource-limited settings.en_US
dc.description.departmentOtorhinolaryngologyen_US
dc.description.librarianhj2023en_US
dc.description.urihttps://www.elsevier.com/locate/ijporlen_US
dc.identifier.citationOpperman, J.B. & Tshifularo, M.I. 2022, 'The application of xylocaine 10% pump-spray to improve immediate post-adenotonsillectomy pain in children : a randomized controlled trial', International Journal of Pediatric Otorhinolaryngology, vol. 161, art. 111260, pp. 1-7, doi : 10.1016/j.ijporl.2022.111260.en_US
dc.identifier.issn0165-5876 (print)
dc.identifier.issn1872-8464 (online)
dc.identifier.other10.1016/j.ijporl.2022.111260
dc.identifier.urihttp://hdl.handle.net/2263/91936
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.rights© 2022 Elsevier B.V. All rights reserved. Notice : this is the author’s version of a work that was accepted for publication in International Journal of Pediatric Otorhinolaryngology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. A definitive version was subsequently published in International Journal of Pediatric Otorhinolaryngology, vol. 161, art. 111260, pp. 1-7, doi : 10.1016/j.ijporl.2022.111260.en_US
dc.subjectAdenotonsillectomyen_US
dc.subjectTonsillectomyen_US
dc.subjectPainen_US
dc.subjectChildrenen_US
dc.subjectLocal anestheticen_US
dc.subjectXylocaineen_US
dc.subjectEmergence deliriumen_US
dc.subjectLidocaineen_US
dc.subjectLignocaineen_US
dc.subjectSDG-03: Good health and well-beingen_US
dc.titleThe application of xylocaine 10% pump-spray to improve immediate post-adenotonsillectomy pain in children : a randomized controlled trialen_US
dc.typePostprint Articleen_US

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