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Oxycodone and dexamethasone for pain management after tonsillectomy: a placebo-controlled EMG assessed clinical trial.

Vaiman M, Krakovski D, Haitov Z - Med. Sci. Monit. (2011)

Bottom Line: The results were compared with previously established normative database.Statistically significant difference in muscle reactions was detected between the two Groups and the placebo group.Application of oxycodone significantly reduces the postoperative pain.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

ABSTRACT

Background: Surface electromyographic (sEMG) study of post-tonsillectomy swallow-evoked muscular reactions was performed in order to evaluate the efficacy and safety of oxycodone and dexamethasone in pain management after tonsillectomy.

Material/methods: 90 randomly chosen operated adults were divided into three groups. Group 1 (n = 30) was treated with OxyContin (Oxycodone) injections; Group 2 (n = 30) was treated with Dexacort (Dexamethasone), and Group 3 (n = 30) was a placebo group. Pain assessment included visual analogue scale (VAS) pain score and the EMG data like the timing, electric amplitude and graphic patterns of muscular activity during deglutition. We investigated masseter, infrahyoid and submental-submandibular muscles. Records from trapezius muscle were used for control. The results were compared with previously established normative database. The patients were tested 24 h after surgery. The sEMG data were compared with VAS pain score with regard to changes in clinical condition of the patients.

Results: Analgesia with oxycodone smoothed the recorded sEMG swallow peaks and increases time of deglutition. Dexamethasone normalized muscular activity in deglutition in cases with edema as detected by the EMG records. Statistically significant difference in muscle reactions was detected between the two Groups and the placebo group.

Conclusions: Application of oxycodone significantly reduces the postoperative pain. Application of dexamethasone after tonsillectomy is advisable because of the reduction of postoperative morbidity while the reduction of the postoperative pain is secondary to the reduction of edema. SEMG might be used as an adjunctive measure of pain behavior via assessment of muscular reactions to pain and to analgesia.

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Related in: MedlinePlus

A typical single swallow of a patient 24 hours after tonsillectomy before administration of anesthetics or placebo. Green line – MS location, blue line – SUB location, red line – LSM location, yellow line – TZ location. The bolus is swallowed in two shares (A, B) with a dry swallowing aftereffect (C). The LSM line is abnormally high with spasms (1,2,3). TZ line is very high, m. trapezius is tense because of pain. X-axis (horizontal) – time in ms, Y-axis (vertical) – electrical amplitude in μV.
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f1-medscimonit-17-10-pi25: A typical single swallow of a patient 24 hours after tonsillectomy before administration of anesthetics or placebo. Green line – MS location, blue line – SUB location, red line – LSM location, yellow line – TZ location. The bolus is swallowed in two shares (A, B) with a dry swallowing aftereffect (C). The LSM line is abnormally high with spasms (1,2,3). TZ line is very high, m. trapezius is tense because of pain. X-axis (horizontal) – time in ms, Y-axis (vertical) – electrical amplitude in μV.

Mentions: The interelectrode distance was 10 mm. Specific electrode positions were as follows (Figure 1): (1) MS location: Two bipolar stick-on surface electrodes were placed parallel to the masseter muscle fibers. (2) SUB location: Two surface electrodes were attached to the skin beneath the chin on the right or left side of midline to record submental myoelectrical activity over the platisma. (3) LSM location: Two electrodes were placed aside of the thyroid cartilage to record from the infrahyoid (laryngeal strap) muscles. The exact electrode positions (Figure 1) for each muscle group are known since the 19th century, and in addition were clarified following anatomical correlates [17]. The electrode placement technique was described in several publications [18–20]. Each pair of electrodes had a third electrode as ground. Electrical impedance at sites of electrode contact was reduced, as target areas were lightly scrubbed with alcohol gauze pads, followed by application of an electrode gel.


Oxycodone and dexamethasone for pain management after tonsillectomy: a placebo-controlled EMG assessed clinical trial.

Vaiman M, Krakovski D, Haitov Z - Med. Sci. Monit. (2011)

A typical single swallow of a patient 24 hours after tonsillectomy before administration of anesthetics or placebo. Green line – MS location, blue line – SUB location, red line – LSM location, yellow line – TZ location. The bolus is swallowed in two shares (A, B) with a dry swallowing aftereffect (C). The LSM line is abnormally high with spasms (1,2,3). TZ line is very high, m. trapezius is tense because of pain. X-axis (horizontal) – time in ms, Y-axis (vertical) – electrical amplitude in μV.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539460&req=5

f1-medscimonit-17-10-pi25: A typical single swallow of a patient 24 hours after tonsillectomy before administration of anesthetics or placebo. Green line – MS location, blue line – SUB location, red line – LSM location, yellow line – TZ location. The bolus is swallowed in two shares (A, B) with a dry swallowing aftereffect (C). The LSM line is abnormally high with spasms (1,2,3). TZ line is very high, m. trapezius is tense because of pain. X-axis (horizontal) – time in ms, Y-axis (vertical) – electrical amplitude in μV.
Mentions: The interelectrode distance was 10 mm. Specific electrode positions were as follows (Figure 1): (1) MS location: Two bipolar stick-on surface electrodes were placed parallel to the masseter muscle fibers. (2) SUB location: Two surface electrodes were attached to the skin beneath the chin on the right or left side of midline to record submental myoelectrical activity over the platisma. (3) LSM location: Two electrodes were placed aside of the thyroid cartilage to record from the infrahyoid (laryngeal strap) muscles. The exact electrode positions (Figure 1) for each muscle group are known since the 19th century, and in addition were clarified following anatomical correlates [17]. The electrode placement technique was described in several publications [18–20]. Each pair of electrodes had a third electrode as ground. Electrical impedance at sites of electrode contact was reduced, as target areas were lightly scrubbed with alcohol gauze pads, followed by application of an electrode gel.

Bottom Line: The results were compared with previously established normative database.Statistically significant difference in muscle reactions was detected between the two Groups and the placebo group.Application of oxycodone significantly reduces the postoperative pain.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

ABSTRACT

Background: Surface electromyographic (sEMG) study of post-tonsillectomy swallow-evoked muscular reactions was performed in order to evaluate the efficacy and safety of oxycodone and dexamethasone in pain management after tonsillectomy.

Material/methods: 90 randomly chosen operated adults were divided into three groups. Group 1 (n = 30) was treated with OxyContin (Oxycodone) injections; Group 2 (n = 30) was treated with Dexacort (Dexamethasone), and Group 3 (n = 30) was a placebo group. Pain assessment included visual analogue scale (VAS) pain score and the EMG data like the timing, electric amplitude and graphic patterns of muscular activity during deglutition. We investigated masseter, infrahyoid and submental-submandibular muscles. Records from trapezius muscle were used for control. The results were compared with previously established normative database. The patients were tested 24 h after surgery. The sEMG data were compared with VAS pain score with regard to changes in clinical condition of the patients.

Results: Analgesia with oxycodone smoothed the recorded sEMG swallow peaks and increases time of deglutition. Dexamethasone normalized muscular activity in deglutition in cases with edema as detected by the EMG records. Statistically significant difference in muscle reactions was detected between the two Groups and the placebo group.

Conclusions: Application of oxycodone significantly reduces the postoperative pain. Application of dexamethasone after tonsillectomy is advisable because of the reduction of postoperative morbidity while the reduction of the postoperative pain is secondary to the reduction of edema. SEMG might be used as an adjunctive measure of pain behavior via assessment of muscular reactions to pain and to analgesia.

Show MeSH
Related in: MedlinePlus