Adult tonsillectomy: postoperative pain depends on indications / Tonsilectomia no adulto: a dor pós-operatória depende das indicações

ABSTRACT INTRODUCTION: Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain. OBJECTIVE: To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis. METHODS: A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP) laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis) and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5 mg Tramadoli hydrochloridum + 325 mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers. RESULTS: Indications for the surgery were: recurrent acute tonsillitis (34 patients), no history of recurrent tonsillitis: focus tonsil (20) and intense malodour (7). Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP) 9.5- and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers were observed. CONCLUSION: Patients with recurrent tonsillitis qualified for tonsillectomy reported lower pain intensity than those without recurrent tonsillitis and the pain scores were unrelated to nerve fibers density.

Resumo Introdução: Dor intensa é uma das queixas mais importantes no pós-operatório de uma tonsilectomia. Com frequência, essa dor é descrita pelos pacientes, como comparável à dor que acompanha a tonsilite aguda. Apesar da tonsilite recorrente ser a indicação mais frequente para cirurgia, muitas tonsilectomias são realizadas por outras indicações, e esses pacientes podem não estar familiarizados com essa dor. Objetivo: Verificar se indivíduos com tonsilite recorrente apresentam diferenças na intensidade dolorosa pós-tonsilectomia vs. pacientes com outras indicações para cirurgia, sem histórico de episódios de tonsilite aguda. Método: Foram realizadas 61 tonsilectomias sob anestesia geral, com o uso de um laser potassium titanyl phosphate (KTP) (para que fosse eliminada uma possível influência de uma dissecção agressiva das tonsilas fibrosadas em pacientes com história de tonsilite recorrente), e hemostasia através de ligaduras de vasos sanguíneos nos leitos tonsilares. Os pacientes foram medicados com 37,5 mg de cloridrato de tramadol + 325 mg de paracetamol (comprimidos) durante 10 dias. As variáveis pós-operatórias foram tempo de internação hospitalar, hemorragia e percentual de readmissão. Os pacientes forneceram informações sobre a intensidade da dor em dias consecutivos, duração da dor, perda de peso corpóreo no dia 10 do pós-operatório, intensidade e duração da dificuldade de deglutição, e necessidade de doses adicionais de analgésicos. A velocidade de cicatrização também foi avaliada. Fibras nervosas capsulares foram examinadas histologicamente nas tonsilas resecadas com o uso de imunocorantes para marcadores de fibras nervosas gerais e de sensibilidade. Resultados: As indicações para a cirurgia foram: tonsilite aguda recorrente (34 pacientes), ausência de história de tonsilite recorrente - Tonsilite focal (20) e halitose (7). A intensidade da dor nos dias 3-4 do pós-operatório e a incidência de reinternações em decorrência de desidratação foram significativamente mais altas no grupo sem história de tonsilite recorrente. Não foram observadas diferenças significantes nas densidades relativas de fibras nervosas imunorreativas para protein gene product (PGP) 9.5 e calcitonin gene-related peptide (CGRP). Conclusão: Os pacientes com tonsilite recorrente e qualificados para tonsilectomia informaram menor intensidade da dor em relação aos pacientes sem histórico se tonsilite recorrente, e os escores para dor não apresentaram relação com a densidade das fibras nervosas.

Adult tonsillectomy: postoperative pain depends on indications.

INTRODUCTION: Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain. OBJECTIVE: To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis. METHODS: A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP) laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis) and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5mg Tramadoli hydrochloridum+325mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers. RESULTS: Indications for the surgery were: recurrent acute tonsillitis (34 patients), no history of recurrent tonsillitis: focus tonsil (20) and intense malodour (7). Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP) 9.5- and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers were observed. CONCLUSION: Patients with recurrent tonsillitis qualified for tonsillectomy reported lower pain intensity than those without recurrent tonsillitis and the pain scores were unrelated to nerve fibers density.