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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 after Oxycontin was administered. Green line – MS location, blue line – SUB location, red line – LSM location, yellow line – TZ location. Normal sharp apexes are gone, m. trapezius is absolutely relaxed. X-axis (horizontal) – time in ms, Y-axis (vertical) – electrical amplitude in μV.
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f2-medscimonit-17-10-pi25: A typical single swallow of a patient 24 hours after tonsillectomy after Oxycontin was administered. Green line – MS location, blue line – SUB location, red line – LSM location, yellow line – TZ location. Normal sharp apexes are gone, m. trapezius is absolutely relaxed. X-axis (horizontal) – time in ms, Y-axis (vertical) – electrical amplitude in μV.

Mentions: For the Group 1, the EMG records showed graphic effect of oxycodone action. A typical single water swallow of a healthy individual between 18 and 70 years of age was observed graphically at the rectified and low-pass filtered sEMG as a normal wave with upward deflections and a sharp apex when recorded from the MS, SUB and LSM locations [8,9,18]. When a patient is in pain, the swallow becomes absolutely disorganized. (Figure 1). When the surface EMG record of a swallow was performed after oxycodone had been administered, it was clearly seen that the sharp apexes were gone and the swallow waves looked smoth (Figure 2). The dexamethasone group (Group 2) EMG records indicated that dexamethasone did not affect muscles the same way as oxycodone did but nevertheless improved the swallow pattern towards its normalization (Figure 3). This positive effect, however, was observed only in 43% of cases (13 out of 30). Clinical data of these 13 patients indicated significant edema around the operated site that was reduced after dexamethasone was administered. For these patients, the throat edema severity rating scale (Table 3) indicated mean 4.1 before and 2.3 after the treatment (p<0.05). The records taken from the patients of the placebo group (Group 3) did not show even these changes (Figure 4).


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 after Oxycontin was administered. Green line – MS location, blue line – SUB location, red line – LSM location, yellow line – TZ location. Normal sharp apexes are gone, m. trapezius is absolutely relaxed. 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

f2-medscimonit-17-10-pi25: A typical single swallow of a patient 24 hours after tonsillectomy after Oxycontin was administered. Green line – MS location, blue line – SUB location, red line – LSM location, yellow line – TZ location. Normal sharp apexes are gone, m. trapezius is absolutely relaxed. X-axis (horizontal) – time in ms, Y-axis (vertical) – electrical amplitude in μV.
Mentions: For the Group 1, the EMG records showed graphic effect of oxycodone action. A typical single water swallow of a healthy individual between 18 and 70 years of age was observed graphically at the rectified and low-pass filtered sEMG as a normal wave with upward deflections and a sharp apex when recorded from the MS, SUB and LSM locations [8,9,18]. When a patient is in pain, the swallow becomes absolutely disorganized. (Figure 1). When the surface EMG record of a swallow was performed after oxycodone had been administered, it was clearly seen that the sharp apexes were gone and the swallow waves looked smoth (Figure 2). The dexamethasone group (Group 2) EMG records indicated that dexamethasone did not affect muscles the same way as oxycodone did but nevertheless improved the swallow pattern towards its normalization (Figure 3). This positive effect, however, was observed only in 43% of cases (13 out of 30). Clinical data of these 13 patients indicated significant edema around the operated site that was reduced after dexamethasone was administered. For these patients, the throat edema severity rating scale (Table 3) indicated mean 4.1 before and 2.3 after the treatment (p<0.05). The records taken from the patients of the placebo group (Group 3) did not show even these changes (Figure 4).

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