Analgesia
Conditions
Brief summary
The aim of the present study is to evaluate the efficacy and safety of Ultra-sound guided submandibular parapharyngeal glossopharyngeal nerve block as regards time for first need of analgesic as a primary outcome as well as pain score, total postoperative analgesic requirement, and incidence of complications as secondary outcomes
Detailed description
Tonsillectomy is one of the most frequent surgical procedures performed all over the world that has been identified as being severely painful especially in the adult population. Management of post tonsillectomy pain is of paramount importance in order to improve swallowing and enhance oral intake as well as to decrease the risk of dehydration, infection and secondary hemorrhage with a subsequent hastening of recovery. A variety of analgesic regimens have been implemented to alleviate post-tonsillectomy pain, however; no consensus on the ideal analgesic regimen has been yet identified. The Ultrasound (US)-guided glossopharyngeal nerve (GPN) block has been acknowledged as a feasible option for providing perioperative analgesia in tonsillectomy patients. It blocks sensory impulses from the posterior third of the tongue, palatine tonsil, and mucous membranes of the mouth and pharynx. Conventional techniques for blocking the GPN carry the risk of vascular puncture, inadvertent block of closely adjacent other cranial nerves, with increased probability of local anesthetic toxicity and even upper airway obstruction. Recently, a novel, safe, and reproducible US-guided GPN block technique has been introduced by Azman et al, which would block the GPN distally, in the tissue plane just next to the pharyngeal wall and relatively far from high risk nearby structures.
Interventions
PROCEDUREbilateral ultrasound guided GPN block
a linear high frequency ultrasound probe will be initially positioned over the hyoid bone in the transverse plane, then the probe will be rotated to keep in line with the mandibular angle and the pharyngeal wall is identified by US. Using an in plane approach, a 22 G ,5 cm needle will be advanced till it reaches just superficial to the pharyngeal wall and 2.2 ml of 0.25% bupivacaine will be injected.
Sponsors
Gehan Morsy Eid
Aliaa Muhammad Belal
Mohamed Shebl Abdelghany
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Patients classified by the American society of Anesthesiologists ASA I and II patients * Scheduled for tonsillectomy procedure
Exclusion criteria
* Patients' refusal * History of diabetes mellitus, * Cardiac, liver or renal impairment * Obstructive sleep apnea syndrome * Swallowing difficulty * Intake of chronic pain medications or substance abuse * Bleeding disorders * Hypersensitivity to the used medication
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Onset of 1st analgesic request | up to 24 hours postoperative | the time to first analgesic request will be recorded |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain score | at 30 minutes, 2 hours, 6 hours, 12 hours, and 24 hours postoperative | The numerical rating scale for pain ranging from 0-10 where the minimum value of 0 represents no pain and the maximum value of 10 represent the worst pain imaginable |
| Postoperative rescue analgesic consumption | up to 24hours postoperative | Total 24 hours postoperative rescue analgesic consumption |
Countries
Egypt
Outcome results
None listed