Zayuah, Mat Sulaiman
(2008)
Comparison between viscous lignocaine and rectal diclofenac for immediate postoperative analgesia in paediatric
tonsillectomy.
Masters thesis, Universiti Sains Malaysia.
Abstract
Tonsillectomy is a common surgical procedure in children. Pain after tonsillectomy is
inevitable and causes not only distress, but also dehydration, difficulty in eating and
delayed post-operative recovery. Previous studies in the pediatric population have
demonstrated a significant decrease in post operative pain and morbidity by using local
analgesic but the effectiveness in relieving pain has not been formally assessed and there
is no study done using viscous lignocaine for the pain reduction following tonsillectomy.
It is very important to determine weather topical can replace other form of medication in
the management of immediate post-operative pain.
Objectives
The goal of this study was to find out the effectiveness of viscous lignocaine for
immediate pediatric post-tonsillectomy pain in comparison to r~ctal diclofenac.
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Specific objective include to determine weather peri-operative viscous lignocaine
effectively reduces immediate incisional pain in tonsillectomy patients using Visual
Analogue Score (VAS) between the groups and reduction in post-operative analgesic
requirement as a rescue analgesic in pediatric tonsillectomy patients. It also to assess the
ability of the patients following tonsillectomy to start oral feeding.
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Methodology
130 patients aged between 5 to 12 years old were randomly allocated to two groups to
receive either viscous lignocaine or rectal diclofenac as post-operative analgesic. Patients
will be randomized into 2 groups, using computer generated simple random sampling. 65
patients are assigned into group A ( viscous lignocaine ) and another 65 in group B
( rectal diclofenac ). Group A : Patients given 3 mls of viscous lignocaine 2 % or
maximum of 4mg/kg body weight whereas Group B : Patients were given rectal
diclofenac 1 mg/kg. All patients will be preoxygenated with oxygen and induced with
intravenous fentanyl 1.5mcg/kg, propofol 2 mg!kg and rocuronium 0.5 mg!kg as muscle
relaxant. In the recovery room, vital signs will be charted and pain assessment was done
using VAS 0.5-hour and before discharge to ward. In the ward, patients is then follow up
for 24 hours by Acute Pain Service team and time of resumption oral feeding and total
rescue medication is recorded at 1-hour, 2-hour, 4-hour, 12-hour and 24-hour. If patients
complaining of intolerable pain, rescue medication will be given, intravenous pethidine
0.5 mg/kg and time, frequency and total doses will be recorded at the same time interval.
Result
130 patients completed the study. The result showed that even though statistically not
significant, p=0.4 79; the VAS score was lower in viscous lignocaine group first 4 hours
post-operatively. Haemodynamically, the MAP was significantly reduce in viscous
lignocaine group after 4-hour with p=0.043, at 12-hour p=0.040 and at 24-hour
p=0.044. The dose of rescue medication was significantly reduced at 2-hour postoperation
with p=0.023 and the dose still reduced at 4-hour post-tonsillectomy. The time
for resumption oral feeding were also significantly reduced for oral fluid and oral soft
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diet in viscous lignocaine group with p=0-016 and p=0.007 respectively.
Conclusion
From our study, we conclude that viscous lignocaine is comparable to rectal diclofenac
for post-tonsillectomy analgesia in paediatric patients. Viscous lignocaine does reduced
significantly immediate post-operative pain and result in early return of oral feeding. It is
safe and can reduce the unnecessary complication of systemic analgesia.
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