Topical clindamycin in post-adenotonsillectomy analgesia in children: a double-blind, randomized clinical trial.
OBJECTIVE
Tonsillectomy, with or without adenoidectomy, is one of the most common surgical procedures in pediatric otolaryngology. Pain is the main cause of morbidity in the postoperative period, where it is serious in some cases, leading to odynophagia and resultant complications such as dehydration. We evaluated the effect of topical clindamycin in the reduction of oropharyngeal pain in children who underwent adenotonsillectomy. Secondary outcomes were otalgia, analgesic use, oral bacterial count, type of diet, secondary bleeding, vomiting, fever, and weight loss.


METHODS
Double-blind, randomized clinical trial.


METHODS
Tertiary hospital.


METHODS
Eighty-two children of both sexes between four and 12 years of age who underwent adenotonsillectomy were allocated to receive topical clindamycin or placebo in the immediate preoperative, intraoperative, and eight-to-12-hours postoperative periods. Pain was measured using a faces pain scale for five days.


RESULTS
Reduction of oropharyngeal pain was significant with the use of clindamycin only on the first postoperative day (95% confidence interval, 2.22 to 4.41 [clindamycin] vs 4.53 to 6.3 [placebo]; P = .002). No difference was observed in the aerobic and anaerobic counts by tongue swab between premedication and third-postoperative-day samplings. There were no differences with respect to reduction in otalgia, paracetamol use, return to normal diet, variation in weight, secondary hemorrhage, vomiting, and fever.


CONCLUSIONS
The use of topical clindamycin was beneficial in reducing pain on the first postoperative day, without effect on subsequent days. Future investigations could examine the use of topical clindamycin not only in the first 12 hours but also during five days of follow-up.
Department of Medical Surgery of Universidade Federal de Ciências da Saúde de Porto Alegre and Division of Pediatric Otorhinolaryngology at Hospital da Criança Santo Antônio, Programa de Pós-Graduação em Ciências Médicas-Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. mmiura.voy@terra.com.br
Mauricio Schreiner
MS
Miura
Catia
C
Saleh
Marina
M
de Andrade
Melina
M
Assmann
Lucélia Hernandes
LH
Lima
José Faibes
JF
Lubianca Neto
D000082:Acetaminophen / Q000008:administration & dosage; D000233:Adenoidectomy; D000287:Administration, Topical; D000698:Analgesia; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage*; D004311:Double-Blind Method; D004433:Earache / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D009960:Oropharynx / Q000382:microbiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D014068:Tonsillectomy
D018712:Analgesics, Non-Narcotic; D000900:Anti-Bacterial Agents; D000082:Acetaminophen; D002981:Clindamycin