title: Safety and efficacy of pre-incisional peritonsillar lornoxicam in paediatric post-tonsillectomy pain: a prospective double-blind, placebo-controlled, split-body clinical study.
abstract: OBJECTIVE
  To evaluate the risk of peri-operative bleeding and re-intervention with peritonsillar lornoxicam infiltration in paediatric tonsillectomy.
  
  
  METHODS
  Prospective, randomised, double-blinded, placebo-controlled, split-body study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A total of 68 patients (7-15 years), ASA I-II, scheduled for tonsillectomy divided into two groups (n = 34) to receive bilateral peritonsillar saline infiltration (placebo group) or peritonsillar saline infiltration in one tonsil (placebo side) and 8 mg lornoxicam in the other tonsil (intervention side; study group). Drugs were administered after induction of anaesthesia and before start of surgery.
  
  
  METHODS
  Intra-operative and postoperative bleeding score, platelet aggregometry before and 30 min after study drug administration, the verbal rating pain scale, time to first postoperative analgesic request, total analgesic consumption during 1st 24 h postoperative and adverse effects were evaluated.
  
  
  RESULTS
  The difference in bleeding score between groups did not reach our definition of statistical significance (P < 0.05). Platelet aggregometry tests did not change significantly with time between groups. Lower postoperative pain scores, longer time to first analgesic request (372.76 ± 82.15 versus 64.89 ± 25.76 min P < 0.001) and lower paracetamol consumption (421.76 ± 125.63 versus 690.29 ± 141.47 mg, P < 0.001) were recorded in study group compared with control group. No patient required hospital re-admission or re-operation because of postoperative tonsillar bed bleeding.
  
  
  CONCLUSIONS
  The lack of significant complications suggests that pre-incisional peritonsillar lornoxicam followed by intravenous paracetamol rescue analgesia may be safe for tonsillectomy in children. To avoid conflict with intra-operative bleeding, postoperative infiltration of lornoxicam is recommended.
authors.affiliation: Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: H S
authors.initials: HS
authors.lastname: Abdel-Ghaffar
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: H G
authors.initials: HG
authors.lastname: Abdel-Azeem
authors.affiliation: Otorhinolaryngology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: M M
authors.initials: MM
authors.lastname: Roushdy
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002648:Child; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D014066:Palatine Tonsil; D010894:Piroxicam / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011446:Prospective Studies; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam; C059451:lornoxicam