Ketoprofen and fentanyl for pain after uvulopalatopharyngoplasty and tonsillectomy.
OBJECTIVE
The treatment of postoperative pain after uvulopalatopharyngoplasty (UPPP) and tonsillectomy presents a challenge. Opioids can cause sedation and respiratory depression. Nonsteroidal antiinflammatory drugs can increase postoperative bleeding. The authors have evaluated the severity of postoperative pain and the consumption of opioid in 53 adult patients undergoing either UPPP or tonsillectomy.


METHODS
A prospective, parallel-groups study.


METHODS
A general endotracheal anesthesia was used in each patient. After surgery patients received ketoprofen 1 mg/kg as an intravenous bolus, followed by a continuous infusion of 4 mg/kg during 24 hours. For rescue analgesia patient-controlled intravenous fentanyl was used.


RESULTS
Both UPPP and tonsillectomy are associated with intense postoperative pain. More than 40% of the patients had high pain scores during the first 24 postoperative hours. Postoperative pain after UPPP was more severe and the difference was significant during swallowing (P < .05). The need for fentanyl in the UPPP group was twice that of the tonsillectomy group (P < .01). There was a high interindividual scatter in the patient-controlled fentanyl attempts in both groups. The patients in the UPPP group needed significantly more oxygen supply during recovery (P = .007). No serious adverse effects occurred and none of the patients experienced postoperative bleeding that required any intervention.


CONCLUSIONS
Individually tailored analgesic treatment protocol is essential for patients undergoing UPPP and tonsillectomy to ensure safe and effective pain alleviation.
Virtaniemi
J
J
Department of Otorhinolaryngology, Kuopio University Hospital, Finland.
Kokki
H
H
Nikanne
E
E
Aho
M
M
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007660:Ketoprofen / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010160:Palate, Soft / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000601:surgery*; D012913:Snoring / Q000601:surgery*; D014068:Tonsillectomy; D014609:Uvula / Q000601:surgery
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007660:Ketoprofen; D005283:Fentanyl