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Peritonsillar infiltration of lidocaine with adrenaline is associated with increased risk of secondary post-tonsillectomy haemorrhage

  • H K Tolska (a1), A J Takala (a1) and J Jero (a2)

Abstract

Objectives

In order to evaluate the safety of tonsillectomy among children, we retrospectively studied the incidence of post-operative complications, adverse events and their association with peri-operative medication.

Methods

Data were collected from the medical records of 691 patients aged 1–16 years, including details of post-operative complications (any unplanned contact with the hospital), analgesics, dexamethasone, 5-HT3 antagonists, local anaesthetic and haemostatic agents.

Results

Recovery was complicated in 13.6 per cent of patients, of whom 8.4 per cent were re-admitted to the ward. The most common complication was post-tonsillectomy haemorrhage, experienced by 7.1 per cent of patients. Re-operation under general anaesthesia (for grade III post-tonsillectomy haemorrhage) was required by 4.2 per cent of patients. Peritonsillar infiltration of lidocaine with adrenaline increased the risk of post-tonsillectomy haemorrhage (odds ratio = 4.1; 95 per cent confidence interval = 2.1 to 8.3).

Conclusion

Every seventh paediatric patient experienced a complicated recovery after tonsillectomy, caused by post-tonsillectomy haemorrhage in most cases. Local peritonsillar infiltration of lidocaine with adrenaline was associated with an increased risk of post-tonsillectomy haemorrhage.

Copyright

Corresponding author

Author for correspondence: Dr Hanna Kaisa Tolska, Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11–13, PO Box 263, 00029 HUS, Finland E-mail: kaisa.tolska@hus.fi

Footnotes

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Dr H K Tolska takes responsibility for the integrity of the content of the paper

Footnotes

References

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1Windfuhr, JP. Hemorrhage following pediatric tonsillectomy before puberty. Int J Pediatr Otorhinolaryngol 2001;58:197204
2Randall, D, Hoffer, M. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998;118:61–8
3MacCallum, PL, MacRae, DL, Sukerman, S, MacRae, E. Ambulatory adenotonsillectomy in children less than 5 years of age. J Otolaryngol 2001;30:75–8
4Kanerva, M, Tarkkila, P, Pitkäranta, A. Day-case tonsillectomy in children: parental attitudes and consultation rates. Int J Pediatr Otorhinolaryngol 2003;67:777–84
5Wei, JL, Beatty, CW, Gustafson, RO. Evaluation of posttonsillectomy hemorrhage and risk factors. Otolaryngol Head Neck Surg 2000;123:229–35
6Liu, JH, Anderson, KE, Willging, JP, Myer, CM 3rd, Shott, SR, Bratcher, GO et al. Posttonsillectomy haemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg 2001;127:1271–5
7Valtonen, H, Qvarnberg, Y, Blomgren, K. Patient contact with healthcare professionals after elective tonsillectomy. Acta Otolaryngol 2004;124:1086–9
8Drake-Lee, A, Stokes, M. A prospective study of the length of stay of 150 children following tonsillectomy and/or adenoidectomy. Clin Otolaryngol Allied Sci 1998;23:491–5
9Beaulieu, P. Non-opioid strategies for acute pain management. Can J Anaesth 2007;6:481–5
10Marret, E, Flahault, A, Samama, C-M, Bonnet, F. Effects of postoperative, nonsteroidal, anti-inflammatory drugs on bleeding risk after tonsillectomy. Anesthesiology 2003;98:1497–502
11Cardwell, M, Siviter, G, Smith, A. Non-steroidal anti-inflammatory drugs and perioperative bleeding in pediatric tonsillectomy. Cochrane Database Syst Rev 2005;(18):CD003591
12Hollis, LJ, Burton, MJ, Millar, JM. Perioperative local anesthesia for reducing pain following tonsillectomy. Cochrane Database Syst Rev 2000;(2):CD001874
13Grainger, J, Saravanappa, N. Local anaesthetic for post-tonsillectomy pain: a systematic review and meta-analysis. Clin Otolaryngol 2008;33:411–19
14Patel, RI, Hannallah, RS. Anesthetic complications following pediatric ambulatory surgery: a 3-yr study. Anesthesiology 1988;6:1009–12
15Rose, JB, Brenn, BR, Corddry, DH, Thomas, PC. Preoperative oral ondansetron for pediatric tonsillectomy. Anesth Analg 1996;82:558–62
16Gan, TJ, Meyer, TA, Apfel, CC, Chung, F, Davis, PJ, Habib, AS et al. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007;105:1615–28
17Holte, K, Kehlet, H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 2002;195:694712
18Afman, CE, Welge, JA, Steward, DL. Steroids for post-tonsillectomy pain reduction: meta-analysis of randomized controlled trials. Otolaryngol Head Neck Surg 2006;134:181–6
19Czarnetzki, C, Elia, N, Lysakowski, C, Dumont, L, Landis, BN, Giger, R et al. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA 2008;300:2621–30
20Anand, VT, Phillipps, JJ, Allen, D, Joynson, DH, Fielder, HM. A study of postoperative fever following paediatric tonsillectomy. Clin Otolaryngol Allied Sci 1999;24:360–4
21Windfuhr, J, Seehafer, M. Classification of haemorrhage following tonsillectomy. J Laryngol Otol 2001;115:457–61
22Ovesen, T, Kamarauskas, G, Dahl, M, Mainz, J. Pain and bleeding are the main determinants of unscheduled contacts after outpatient tonsillectomy. Dan Med J 2012;59:A4382
23Duval, M, Wilkes, J, Korgenski, K, Srivastava, R, Meier, J. Causes, costs, and risk factors for unplanned return visits after adenotonsillectomy in children. Int J Pediatr Otorhinolaryngol 2015;79:1640–6
24Blakley, BW. Post-tonsillectomy bleeding: how much is too much? Otolaryngol Head Neck Surg 2009;140:288–90
25Coordes, A, Soudry, J, Hofmann, VM, Lenarz, M. Gender-specific risk factors in post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol 2016;273:4535–41
26Thorisdottir, H, Ratnoff, OD, Maniglia, AJ. Activation of Hageman factor (factor XII) by bismuth subgallate, a hemostatic agent. J Lab Clin Med 1998;112:481–6
27Callanan, V, Curran, AJ, Smyth, DA, Gormley, PK. The influence of bismuth subgallate and adrenaline paste upon operating time and operative blood loss in tonsillectomy. J Laryngol Otol 1995;109:206–8
28Hatton, RC. Bismuth subgallate-epinephrine paste in adenotonsillectomies. Ann Pharmacother 2000;34:522–5
29Papangelou, L. Hemostasis in tonsillectomy. A comparison of electrocoagulation and ligation. Arch Otolaryngol 1972;96:358–60
30Sivamani, RK, Pullar, CE, Manabat-Hidalgo, CG, Rocke, DM, Carlsen, RC, Greenhalgh, DG et al. Stress-mediated increases in systemic and local epinephrine impair skin wound healing: potential new indication for beta blockers. PLoS Med 2009;6:e12
31Peitzman, ER, Zaidman, NA, Maniak, PJ, O'Grady, SM. Agonist binding to β-adrenergic receptors on human airway epithelial cells inhibits migration and wound repair. Am J Physiol Cell Physiol 2015;309:C84755
32Dasu, MR, Ramirez, SR, La, TD, Gorouhi, F, Nguyen, C, Lin, BR et al. Crosstalk between adrenergic and toll-like receptors in human mesenchymal stem cells and keratinocytes: a recipe for impaired wound healing. Stem Cells Transl Med 2014;3:745–59
33Lucchinetti, E, Awad, AE, Rahman, M, Feng, J, Lou, PH, Zhang, L et al. Antiproliferative effects of local anesthetics on mesenchymal stem cells: potential implications for tumor spreading and wound healing. Anesthesiology 2012;116:841–56
34Rodrigues, FV, Hochman, B, Wood, VT, Simões, MJ, Juliano, Y, Ferreira, LM. Effects of lidocaine with epinephrine or with buffer on wound healing in rat skin. Wound Repair Regen 2011;19:223–8
35Doğan, N, Uçok, C, Korkmaz, C, Uçok, O, Karasu, HA. The effects of articaine hydrochloride on wound healing: an experimental study. J Oral Maxillofac Surg 2003;61:1467–70
36Waite, A, Gilliver, SC, Masterson, GR, Hardman, MJ, Ashcroft, GS. Clinically relevant doses of lidocaine and bupivacaine do not impair cutaneous wound healing in mice. Br J Anaesth 2010;104:768–73
37Isaacson, G. Tonsillectomy healing. Ann Otol Rhinol Laryngol 2012;121:645–9
38Lewis, SR, Nicholson, A, Cardwell, ME, Siviter, G, Smith, AF. Nonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev 2013;(18):CD003591
39D'Souza, JN, Schmidt, RJ, Xie, L, Adelman, JP, Nardone, HC. Postoperative nonsteroidal anti-inflammatory drugs and risk of bleeding in pediatric intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol 2015;79:1472–6
40FDA Drug Safety Communication. Safety review update of codeine use in children; new Boxed Warning and Contraindication on use after tonsillectomy and/or adenoidectomy. In: https://www.fda.gov/downloads/Drugs/DrugSafety/UCM339116.pdf [20 February 2013]
41Ciszkowski, C, Madadi, P, Phillips, MS, Lauwers, AE, Koren, G. Codeine, ultrarapid-metabolism genotype, and postoperative death. N Engl J Med 2009;361:827–8
42Gunter, JB, Willging, JP, Myer, CM 3rd. Dexamethasone and postoperative bleeding after tonsillectomy in children. JAMA 2009;301:1765–6
43Steward, DL, Grisel, J, Meinzen-Derr, J. Steroids for improving recovery following tonsillectomy in children. Cochrane Database Syst Rev 2011;(10):CD003997
44Bellis, JR, Pirmohamed, M, Nunn, AJ, Loke, YK, De, S, Golder, S et al. Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2014;113:2023–42
45Baugh, RF, Archer, SM, Mitchell, RB, Rosenfeld, RM, Amin, R, Burns, JJ et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011;144:S130
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  • EISSN: 1748-5460
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